严重创伤患者并发弥散性血管内凝血的护理

目的 探讨严重创伤患并发弥散性血管内凝血(DIC)的预防和治疗，以提高抢救成功率。方法 1998年1月—2002年1月，我科收治严重创伤患132例，发生DIC24例，予以控制病因，纠正休克，改善微循环及控制并发症等积极治疗。结果 发生DIC的24例中，治愈15例，死亡9例。结论 早期消除病因及诱因，防止休克及多器官功能障碍综合征(MODS)的发生，严密观察DIC发生的早期征象，提高对凝血机理及成分输血的认识，是预防及抢救DIC的有效措施。     

78例弥散性血管内凝血患者血浆D-二聚体水平分析

目的 探讨血浆D-二聚体水平对弥散性血管内凝血(DIC)的诊断价值.方法 采用免疫比浊法检测DIC患者78例(DIC组)、正常人80例(对照组)血浆中D-二聚体水平.结果 DIC组血浆D-二聚体水平显著高于正常对照组(P<0.01).结论 D-二聚体是诊断DIC较敏感的指标.     

血浆置换在小儿弥散性血管内凝血的治疗作用

目的观察血浆置换在小儿弥散性血管内凝血治疗中的作用。方法选择临床确诊为小儿弥散性血管内凝血的患儿34例,在积极治疗原发病的基础上给予血浆置换治疗,观察血浆置换前后患儿的出血情况,凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(Fib)、抗凝血酶Ⅲ(ATⅢ)及D-二聚体等指标变化。结果通过血浆置换治疗后,34例患儿出血情况减轻,除血小板变化不大外,PT、APTT及Fib明显改善,ATⅢ明显升高,D-二聚体明显降低。结论血浆置换在小儿弥散性血管内凝血的治疗中临床疗效显著。     

创伤弥散性血管内凝血的急救护理

目的:探讨严重创伤并发弥散性血管内凝血(DIC)的预防、治疗与急救护理,以提高抢救成功率。方法:对38例创伤DIC患者予以紧急处理,加强监护及早发现DIC征象,做好心理护理配合治疗与护理。结果:38例创伤DIC患者中死亡15例,自动出院10例,治愈13例。结论:及早发现并积极采取多种有效的护理措施,可降低创伤DIC的发生率和病死率。     

氯吡格雷治疗急性脑梗死患者血浆GMP-140的改变与意义

目的 :观察氯吡格雷治疗急性脑梗死后患者血浆GMP - 14 0 (血小板а颗粒膜蛋白 - 14 0 )的变化并探讨其临床意义。方法 :对 6 0例起病在 2 4h的脑梗死患者随机分为治疗组和对照组 ,分别给予氯吡格雷及普通治疗 ,采用双抗体夹心酶联免疫吸附法分别测定治疗组和对照组患者治疗前后的血浆GMP - 14 0含量。结果 :治疗组患者的血浆GMP - 14 0显著低于对照组 (P<0 .0 1)。结论 :氯吡格雷有抑制血小板活化的作用     

弥散性血管内凝血患者应使用手工法计数血小板

我们应用KX 2 1血液分析仪发现弥散性血管内凝血(DIC)患者的血小板计数仪器法和手工法结果有很大差异。现将 7例DIC病人血小板计数结果列于表 1。统计结果显示 ,仪器法计数明显高于手工法。分析其原因 ,是由于病人血管内溶血产生的红细胞碎片对仪器法计数血小板所造成的正向干扰引起的。血小板直方图显示血小板低鉴别线相对度数超过规定值 (PL) ,血小板体积分布宽度 (PDW )超出正常值。在日常工作中若发现以上提示符或临床怀疑DIC的病人应做手工法计数血小板。DIC患者早期即有血管内溶血现象 ,而血小板计数是诊断DIC的重要指标 ,上…     

严重产后出血致弥散性血管内凝血患者血浆与红细胞输注比值研究

目的 探讨严重产后出血致弥散性血管内凝血(DIC)时血浆与红细胞的输注比值,以便制定产科DIC患者的输血方案。方法 选择2008年1月～2019年12月在本院产科分娩时因严重产后出血致DIC并成功救治的产妇共82人为研究对象,根据抢救DIC患者期间输注成分血时血浆/红细胞比值范围(0.4～2.0),按照0.4的比值间隔将纳入对象分为1组：0.4～0.8(中位数0.7,n=13);2组：>0.8～1.2(中位数1.0,n=30);3组：>1.2～1.6(中位数1.3,n=30);4组：>1.6～2.0(中位数1.8,n=9);收集4组产妇的一般情况、分娩方式、救治过程中行子宫动脉灌注栓塞术及手术的例数等资料,以及临床自产后出血起每1～2 h测定1次至病情稳定时的血常规与凝血功能指标;收集并对比4组产妇的24 h出血量、DIC期间及整个救治过程中悬浮红细胞(简称悬红)、新鲜冰冻血浆(FFP)、单采血小板、冷沉淀及纤维蛋白原输注量的记录;应用局部加权回归(Lowess)法分析FFP/悬红比值与DIC持续时间的非线性关联,对比4组产妇DIC持续时间。结果 1)DIC患者输注的...     

急性白血病与弥散性血管内凝血

目的分析急性白血病（AL）患者弥散性血管内凝血（DIC）的发生情况，凝血功能改变及其临床意义。方法对67例AL患者、25例AL完全缓解（CR）患者、20例健康体检者进行凝血常规、D-二聚体等检测。结果根据ISTH修订标准，15例AL患者合并DIC，发生率为22．4％，AML与ALL的DIC发生率AML-M3之间无统计学差异（P〉0．05），AML-M3与non-AML-M3的DIC的发生率之间有统计学差异（P〈0．05）。DIC组PT、APTT、TT较对照组、CR组及non-DIC组均明显延长（P〈0．01），而FIB则降低（P〈0．05）。结论AL尤其AML-M3患者容易合并DIC，观察患者凝血功能改变以及出血表现可有助于尽早发现DIC并指导临床预防及治疗，从而有利于改善AL合并DIC患者的临床预后。     

弥散性血管内凝血的实验室检查及其临床价值

1 引 言 DIC是由于血液的凝血机制被激活,体内凝血酶和纤溶酶并存,以出血、微血管栓塞及微循环衰竭为特征的临床综合征[1].DIC发生在多种疾病的基础上,病情复杂,进展迅速,需要快速作出诊断以采取有效的治疗措施,因此,DIC的实验室检查具有十分重要的作用.本文就有关DIC的实验室检查概述如下,以供同行参考.     

弥散性血管内凝血患者D-二聚体实验室检测分析

目的评价弥散性血管内凝血（DIC）患者体内D-二聚体水平,探讨DIC患者应用D-二聚体检查的临床价值。方法对该院收治的30例DIC患者（DIC组）及30例非DIC患者（对照组）进行D-二聚体检测,比较2组患者D-二聚体水平。同时按照DIC分期将30例DIC患者分为高凝期组、消耗性低凝期组及纤溶亢进期组,比较不同时期患者体内D-二聚体的水平并探讨两者间的相关性。结果 DIC组患者D-二聚体水平明显高于对照组患者,差异有统计学意义（t=11.229,P=0.000）,而纤溶亢进期患者体内D-二聚体水平最高,其次为消耗性低凝期,高凝期最低,差异有统计学意义（Z=-4.785,P=0.000）。同时DIC患者体内D-二聚体水平与DIC分期存在显著的正向直线相关关系（R=0.982,P=0.000）。结论 DIC患者体内D-二聚体水平明显高于非DIC患者,且DIC不同时期D-二聚体水平也存在差异,可用于对DIC患者病情的预测。     

血小板参数及GMP-140在Ⅱ型糖尿病患者中的变化

目的 探讨血小板参数及GMP-140在Ⅱ型糖尿病患者中的变化.方法 对50例Ⅱ型糖尿病患者及50例健康体检者进行血小板及其参数、GMP-140的测量.结果 与对照组相比,Ⅱ型糖尿病患者中血小板、平均血小板容积、血小板体积分布宽度及大血小板比率均有显著性变化(MPV分别为12.11±1.21 fl和11.07±0.96 fl,PLT分别为182±54×109/L和225±59,P-LCR分别为41.25±9.55%和32.14±8.77%,PDW分别为17.06±4.26 fl和14.85±3.12 fl,P均＜0.01),GMP-140含量显著高于对照组(29.1±9.8 ng/ml和9.3±6.7 ng/ml,P＜0.01),GMP-140含量与MPV为正相关关系(r=0.59,P＜0.01).结论 血小板参数及GMP-140在Ⅱ型糖尿病患者中有显著性改变,提示糖尿病患者存在着血小板活化及凝血活性增高的现象,血小板活性改变在糖尿病患者的病情发展及血栓性并发症的发生中起着一定的作用.     

Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) is a serious condition associated with sepsis. Clinical management of DIC is hampered by lack of clear diagnostic criteria. The International Society on Thrombosis and Haemostasis (ISTH) has proposed a diagnostic scoring algorithm for overt DIC based on routine laboratory tests. The objective was to assess a modified version of the ISTH scoring system and determine the effect of drotrecogin alfa (activated) (DrotAA, recombinant human activated protein C) on patients with DIC. The large database from the PROWESS clinical trial in severe sepsis was retrospectively used to assess a modified ISTH scoring system. Baseline characteristics and treatment effects of DrotAA were evaluated. At baseline, 29% (454/1568) of patients had overt DIC. Overt DIC was a strong predictor of mortality, independent of APACHE II score and age. Placebo-treated patients with overt DIC had higher mortality than patients without (43 vs. 27%). DrotAA-treated patients with overt DIC had a trend towards greater relative risk reduction in mortality than patients without (29 vs. 18%, P = 0.261) but both groups had greater relative risk reduction than placebo-treated patients. Serious bleeding rates during DrotAA infusion in patients with and without overt DIC were slightly increased (P = 0.498), compared with placebo, while clinically overt thrombotic events during the 28-day period were slightly reduced (P = 0.144). Modified ISTH overt DIC scoring may be useful as an independent assessment for identifying severe sepsis patients at high risk of death with a favorable risk/benefit profile for DrotAA treatment. Patients without overt DIC also received significant treatment benefit.     

低分子肝素在弥散性血管内凝血患者的应用研究

目的研究低分子肝素应用于治疗弥散性血管内凝血(DIC)的临床疗效和安全性。方法将87例DIC患者按照治疗药物不同分为低分子肝素组和普通肝素组。观察监测凝血功能、疗效、28 d病死率以及不良反应。结果研究组治愈率以及有效率较对照组高,但差异无统计学意义,各症状的疗效也相当,但其对于部分凝血活酶(APTT)延长的影响更小,治疗后研究组APTT延长的患者数明显减少,而对照组治疗后APTT延长的患者数有所增高,研究组28 d死亡率与对照组相似,但出血例数更少。结论低分子肝素疗效与普通肝素相似,但出血等不良反应更少,更为安全有效。     

Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation

BACKGROUND: Disseminated intravascular coagulation (DIC) is a serious complication of sepsis that is associated with a high mortality. OBJECTIVES: Using the adapted International Society on Thrombosis and Haemostasis (ISTH) diagnostic scoring algorithm for DIC, we evaluated the treatment effects of high-dose antithrombin (AT) in patients with severe sepsis with or without DIC. PATIENTS AND METHODS: From the phase III clinical trial in severe sepsis (KyberSept), 563 patients were identified (placebo, 277; AT, 286) who did not receive concomitant heparin and had sufficient data for DIC determination. RESULTS: At baseline, 40.7% of patients (229 of 563) had DIC. DIC in the placebo-treated patients was associated with an excess risk of mortality (28-day mortality: 40.0% vs. 22.2%, P < 0.01). AT-treated patients with DIC had an absolute reduction in 28-day mortality of 14.6% compared with placebo (P = 0.02) whereas in patients without DIC no effect on 28-day mortality was seen (0.1% reduction in mortality; P = 1.0). Bleeding complications in AT-treated patients with and without DIC were higher compared with placebo (major bleeding rates: 7.0% vs. 5.2% for patients with DIC, P = 0.6; 9.8% vs. 3.1% for patients without DIC, P = 0.02). CONCLUSIONS: High-dose AT without concomitant heparin in septic patients with DIC may result in a significant mortality reduction. The adapted ISTH DIC score may identify patients with severe sepsis who potentially benefit from high-dose AT treatment.     

Case of scrub typhus complicated by severe disseminated intravascular coagulation and death

Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82‐year‐old man complained of fever 4 days after climbing a mountain. The patient was admitted to an urban hospital, and meropenem and ceftriaxone were administered. The patient's condition deteriorated and he was transferred to a second hospital. On physical examination, a black scab was found and scrub typhus was suspected. Despite intensive treatment, the patient died on the fifth day. High levels of O. tsutsugamushi IgM antibody were confirmed. An autopsy revealed systemic vasculitis and perivasculitis. The endothelial tissue of the white pulp of the spleen was markedly infiltrated by plasma cells. The authors speculated that a severe immune reaction against O. tsutsugamushi enhanced an inflammatory response, leading to DIC. This case is a warning to doctors who are not familiar with scrub typhus.     

Preliminary study of microparticle coagulation properties in septic patients with disseminated intravascular coagulation

BackgroundSepsis typically results in enhanced coagulation system activation and microthrombus formation. Microparticle (MP) production promotes coagulation and enhances pro-coagulation. This study investigated how circulating MP levels and tissue factor-bearing MP (TF+-MP) activity caused coagulation in patients with septic disseminated intravascular coagulation (DIC).MethodsThirty patients with septic DIC and 30 healthy controls were studied from December 2017 to March 2019. Patient blood samples were collected at enrolment (day 1) and on days 3 and 5; DIC scores and Sequential Organ Failure Assessment (SOFA) scores were recorded. TF+-MP activity was measured using TF-dependent factor Xa generation experiments. Circulating MP concentrations were determined by MP capture assay. Clotting factor activity, antithrombin level, soluble thrombomodulin, and serum tissue factor pathway inhibitor (TFPI) concentrations were measured.ResultsPatients with septic DIC had lower circulating MP levels than healthy control patients. Circulating MP levels in patients with septic DIC were positively correlated with DIC scores and negatively correlated with coagulation factors, but TF+-MP activity did not correlate with clotting factor levels and TFPI.ConclusionsIn patients with septic DIC, circulating MP levels are important in promoting coagulation activation and increasing clotting factor consumption. TF+-MP activity may not be the main form of active TF.     

急性白血病并发弥散性血管内凝血患儿早期及干预后血凝指标变化

目的:探讨急性白血病(AL)患儿并发弥散性血管内凝血(DIC)早期及干预后血凝指标变化。方法:本实验分3组即健康对照组;AL组;AL并发DIC组,均于清晨抽取空腹血检测D-二聚体(DD)、纤维蛋白原水平(FBG)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)及抗凝血酶-Ⅲ(AT-Ⅲ)。对AL并发DIC组患儿应用低分子肝素治疗,比较治疗前后各指标变化,采用SPSS10.0软件将各组进行统计学分析。结果:AL组与健康对照组比较,PT延长,FBG降低,DD明显升高,差异有统计学意义(P<0.05),AL并发DIC组与AL组比较,DD明显升高,AT-Ⅲ降低,差异有统计学意义(P<0.05),且与AL组相比,AL并发DIC组DD、AT-Ⅲ阳性率明显升高,且在DIC发病的不同临床阶段均保持在较高水平(80%以上),DD检测阳性率在血栓形成期高达100%。经肝素抗凝治疗后,AT-Ⅲ及FBG明显升高,DD降低,差异有统计学意义(P<0.05)。结论:AL并发DIC患儿存在凝血、纤溶系统的激活,AT-Ⅲ及DD可作为DIC早期诊断的指标,低分子肝素应用有助于改善DIC患儿的预后。     

Effects of pentoxifylline on coagulation profile and disseminated intravascular coagulation incidence in Egyptian septic neonates

Background and objectives: Neonatal sepsis is frequently associated with pathological activation of the coagulation system, leading to microcirculatory derangement and multiple organ dysfunction syndrome (MODS). The key role in the pathogenesis of sepsis has been attributed to proinflammatory cytokines. These trigger the development of disseminated intravascular coagulation (DIC) via the tissue factor‐dependent pathway of coagulation. Pentoxifylline (PTX), a methylxanthine derivative that is used in peripheral vascular disease, has the potential to modify inflammatory response. The current work was designed to evaluate the potential protective effects of PTX against sepsis‐induced microcirculatory derangement in Egyptian neonates. Methods: A double‐blind placebo‐controlled quasi‐randomized design was used. Thirty‐seven neonates with sepsis were randomly allocated into two groups. Seventeen patients were given PTX (5 mg/kg/h for 6 h; for 6 successive days). Twenty patients received equivalent volume of normal saline and represented the placebo group. Prothrombin time (PT), Activated partial thromboplastin time (APTT), fibrinogen, d ‐dimer, C‐reactive protein (CRP), complete blood count (CBC), also hemodynamic parameters comprising arterial blood pressure, heart rate, capillary refill and urinary output were assessed in both groups before and after treatment. Results: Coagulation parameters in the two groups showed no significant differences. However, a higher incidence of DIC was observed in the placebo group neonates. PTX significantly lowered the percentage of bleeding (P = 0·0128) and less frequent use of FFP was observed in the PTX group (35·53% in PTX group vs. 80% in placebo group, P = 0·003). Incidence of MODS was significantly lower (P = 0·037) and hospital stay duration of survivors was significantly shorter (P = 0·044) in the PTX treated‐infants. Conclusion: Pentoxifylline protects against sepsis‐induced microcirculatory derangement in neonates. It significantly lowered the incidence of bleeding and MODS and shortened the length of hospital stay.