弥漫性血管内凝血研究现状

弥漫性血管内凝血的临床结局是阻塞小血管的微血栓形成。严重的弥漫性血管内凝血的病死率很高，可超过８０％。本文综述了弥漫性血管内凝血的发生机理，诊断及治疗，以提高临床医生对其发生后的诊治水平。     

产科弥散性血管内凝血的救治

背景 妊娠期间一些合并症如先兆子痫以及其他严重状态如羊水栓塞等,均可诱发弥散性血管内凝血(disseminated intravascular coagulation,DIC).目的 探讨胎盘在妊娠相关的DIC中所起的作用.内容 介绍与妊娠相关DIC时胎盘引起凝血机制变化的最新发展.趋向 有望将凝血相关新的诊断和治疗方...     

微量肝素治疗术后并发弥散性血管内凝血20例报告

肝素是治疗弥散性血管内凝血 (ＤＩＣ)的主要抗凝血药物 ,但可能引起外科创面或手术切口渗血。我们于 1992年 4月～2 0 0 1年 2月应用微量肝素静脉滴注治疗手术后并发ＤＩＣ患者2 0例 ,收到满意疗效 ,现报告如下。临床资料一、一般资料 :患者男 14例 ,女 6例 ,年龄 11～ 5 6岁。原发病 :车祸伤 11例 ,其中 1例脑外伤在 2ｄ内 3次开颅行硬膜下血肿清除术。结肠肿瘤 2例 ,大面积烧伤 1例 ,坏死性肠炎 1例 ,宫内死胎 5例。合并症 :休克 11例 ,胃出血 7例 ,血尿 5例 ,皮肤淤斑 11例。诊断标准 :按照首届中华血液学学会全国血栓与止血学术会议有…     

严重感染所致弥散性血管内凝血的进展

弥散性血管内凝血（DIC）是一种以血管内出现纤维蛋白,从而导致微血管和小血管血栓形成,并最终引发器官功能不全的综合征[1].它可并发于多种原发（基础）性疾病的晚期.严重感染导致脓毒症是急性DIC发生的最常见的原发疾病,其病死率较高,属于医学领域亟需解决的难题之一.对于这个难题,近几年来取得了一些重要进展.     

弥漫性血管内凝血误诊再手术2例教训

弥漫性血管内凝血误诊再手术２例教训江苏省武进县中医院（２１３１６１）韩木春１９８７年１月至１９９４年１月，我们遇到２例弥漫性血管内凝血（ＤＩＣ）引起的出血被误诊，而再次手术探查腹腔。现分析报告如下．例１．女，３８岁。因骑自行车不慎，跌伤致右上腹部疼痛...     

动脉瘤病人围手术期凝血和纤溶状态及其与预后关系研究

目的 分析动脉瘤病人围手术期凝血与纤溶指标的变化特点及其与预后的关系。方法 回顾性分析2013年1-6月于中国医科大学附属第一医院重症医学科治疗的40例动脉瘤术后病人的临床资料,分析围手术期凝血及纤溶指标变化及其与预后的关系。结果 40例动脉瘤病人术后血小板及纤维蛋白原水平明显低于术前（P<0.05）,ISTH评分平均为（3.4±1.5）分,共7例病人诊断为弥漫性血管内凝血。动脉瘤破裂病人的ISTH评分明显高于未破裂者（P<0.05）。ISTH评分与APACHEⅡ、SOFA评分呈正相关关系（r=0.704、0.694,P<0.05）,ARDS、休克及死亡病人具有更高的ISTH评分。结论 动脉瘤病人围手术期凝血及纤溶系统激活,血小板及纤维蛋白原大量消耗,易发生出凝血功能障碍;ISTH评分高的病人更易发生器官功能损伤,且预后较差。     

老年重症胆道感染的手术治疗

1988年10月至1993年6月,我院共收治胆道疾病1717例,其中65岁以上老年患者584例(2.94％)。其中因重症胆道感染而行手术者52例,本文分析本组资料并讨论老年重症胆道感染的手术治疗问题。临床资料本组52例中,胆囊积脓或坏疽,伴有多量胆汁溢入腹腔者9例,重症化脓性胆管炎或伴胆囊结石或炎症者43例。年龄:65至74岁者21例,75至79岁者7例,80岁以上者     

老年急性胆道感染围手术期的中西医结合治疗

随着社会的老龄化程度日益提高 ,老年急性胆道感染的发病率也相应增加。我院 1998～ 2 0 0 0年间收治 6 0岁以上急性胆道感染 92例。在围手术期间 ,利用中西医结合治疗 ,与 1994～ 1997年间行常规治疗的老年急性胆道感染病例 81例做对照观察 ,发现明显降低了急症手术率 ,减少了术后并发症 ,取得较好疗效。现报告如下。1　临床资料1 1　中西医结合治疗组　本组 92例中 ,男 2 7例 ,女 6 5例 ;年龄为 6 0～ 87岁 ,平均 6 8岁。均有典型右上腹疼痛 ,伴有恶心、呕吐及不同程度右上腹压痛。其中发热者 83例 ,有黄疸者 2 8例 ,符合ｃｈａｒｃｏｔ三…     

骨科手术中发生的急性播散性血管内凝血

播散性血管内凝血 (DIC)是一种严重的获得性出凝血障碍 ,主要是因为病理性激活凝血级联反应导致凝血因子大量消耗而出现矛盾性的出血倾向。骨科手术发生急性DIC的报到还很少。本文报道了一例 72岁男性颈椎手术后死于严重的急性DIC的病例。我们回顾了一些关于骨科手术中发生DIC的病例报道 ,并简述了这种严重并发症的预防、诊断和治疗。     

产后失血性休克致DIC的抢救与护理1例分析

目前由产后出血引起的失血性休克在我国孕产妇死亡原因中居首位,若短时间内不能迅速止血纠正休克,会迅速发展为弥漫性血管内凝血（DIC）。DIC是在原发病基础上,促凝因素导致机体微血管内广泛地生成微血栓,消耗了大量凝血因子和血小板,并伴以继发性纤溶为特征的获得性血栓--出血综合征。DIC本身并不是一个独立的疾病,而是很多疾病发病的一个中间环节和病理过程。它的主要临床症状可归纳为出血、微循环障碍、多器官功能障碍和贫血。产后一旦发生DIC,将严重威胁产妇的生命安全。但是如果能及早发现,及时治疗,尚能挽救患者的生命。因此,当发生产后大出血时要时刻警惕DIC的发生,做到早发现,早诊断,早治疗,为抢救患者生命提供有利时机。在2013年12月21日,本院成功抢救了1例因宫缩乏力致产后失血性休克进而发生弥漫性血管内凝血的产妇,并报道如下。     

Survival from DIC following amniotic fluid embolism

A 30-year-old multigravida of 38 weeks gestation bled profusely at delivery. Coagulation studies revealed disseminated intravascular coagulation and a diagnosis of amniotic fluid embolism was made. Treatment consisted of transfusion of whole blood and administration of a synthetic serine proteinase inhibitor, FOY. Approximately two hours after administration of the latter, bleeding began to cease and vital signs became stable. The patient survived without sequelae.     

Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy

We herein describe a case of successful surgical treatment of isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy. Pathological features of the spleen included multinodular, blood-filled, cyst-like lesions distributed throughout the whole organ. The pathogenesis of isolated splenic peliosis is controversial, and no definitive disease mechanism has been reported. To our knowledge, this is the first report in English of a case like this.     

Successful perioperative management of a patient with idiopathic thrombocytopenic purpura undergoing emergent appendectomy: Report of a case

INTRODUCTIONIdiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelet count and normal bone marrow. Patients with ITP undergoing surgery are thought to have increased risk for postoperative complications because of their thrombocytopenia.PRESENTATION OF CASEwe report the case of a 66-year-old woman with ITP who required an emergency operation for acute appendicitis associated with disseminated intravascular coagulation. Preoperative therapy consisted of platelet transfusions only, and intraoperative hemostasis was achieved. Postoperatively, high-dose intravenous immunoglobulin (IVIg) therapy led to an increased, stable, and adequate platelet count and good hemostasis.DISCUSSIONThe outcome of this case suggests that IVIg therapy is not always required for preoperative management of patients with.CONCLUSIONIVIg therapy may be useful for postoperative management after emergency surgery.     

Melanotic meningioma complicated by disseminated intravascular coagulation

The purpose of this paper is fourfold: First, to confirm the rarity of melanotic meningioma, as we have found only 11 reported cases; second to demonstrate that this tumor is not always totally pigmented, a fact that has not been mentioned before; third, to show an unusual recurrence as a hemorrhagic cystic meningioma 10 years and 8 months after removal; and fourth, to describe the association of disseminated intravascular coagulation, a rare disorder with brain tumors     

Occurrence of disseminated intravascular coagulation (DIC) in obstructive jaundice and its relation to biliary tract infection

Coagulation studies were done on 78 consecutive cases of obstructive jaundice with or without biliary tract infection. Among 26 cases with biliary tract infection 20 cases showed no bleeding tendency but remarkable hypercoagulability with decreased fibrinolytic activity. Other six cases developed diffuse bleeding tendency in addition to the signs of hypotension and multiorgan dysfunction such as oliguria, respiratory distress and mental confusion. Most showed marked coagulation defects characterized by thrombocytopenia, decreased fibrinogen, antithrombin III and plasminogen levels and narrowing of maximal amplitude in thrombelastogram as well as the increase of fibrin degradation products and positive soluble fibrin monomer complexes. All except one died and three cases were autopsied. In two cases postmortem examination revealed multiple fibrin thrombi in lungs and other organs. A cause of the development of bleeding tendency in obstructive jaundice presently observed may likely to be due to the occurrence of disseminated intravascular coagulation (DIC), i.e. hypercoagulability caused by the biliary tract infection is responsible.     

危重病人术中术后DIC的预防及应对方案

弥漫性血管内凝血（DIC）可使许多疾病演进过程复杂化,危重病人发生手术创伤时尤甚。此时血栓形成与出血常同时存在,使临床医师面临两难境地,病死率极高。因此对于外科危重病人,预防重于治疗。预防的重点在于减少危重病人DIC发生的高危因素,如：当术中术后需要输血时,要采取“鸡尾酒式的输血方式”,即输血成分需合理搭配;并给予适当抗炎治疗。此外还应积极纠正低体温、酸中毒、大出血、感染、血液瘀滞等情况。一旦发生DIC,在积极治疗原发病的基础上,适当输注血液制品,酌情使用肝素;并发脓毒血症时,还可使用抗凝血酶或活化蛋白C等;慎用抗纤溶药。     

急性重症胆管炎并发DIC的急诊内镜治疗

目的探讨伴弥散性血管内凝血的急性重症胆管炎的治疗方法。方法对15例伴弥散性血管内凝血(DIC)的急性重症胆管炎(ACST)患者采取急诊内镜治疗,并对患者各项临床资料进行回顾性分析。结果入院8 h内13例患者全部成功完成经鼻胆道引流(ENBD),解除胆道梗阻,引流通畅,DIC得到纠正,12例患者治愈,3例死于多器官功能衰竭。结论急诊内镜治疗对伴弥散性血管内凝血的急性重症胆管炎是安全的、有效的,是该疾病的首选治疗方案。     

肠瘘并腹腔感染16例诊治体会

目的　探讨肠瘘并腹腔感染的早期诊断及治疗。方法　对 1 6例肠瘘并腹腔感染的诊断及治疗进行回顾性分析。结果　本组死亡 1例 ,1 5例早期明确腹腔感染存在后及时作有效彻底的腹腔冲洗及引流 ,而使腹腔感染得到有效的控制。结论　对肠瘘并腹腔感染的病人 ,首先明确是否存在腹腔感染 ,早期彻底的腹腔冲洗及通畅有效的腹腔及脓肿引流 ,是控制感染治愈肠瘘的关键