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...     

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...     

重症肝素诱发血小板减少症并发播散性血管内凝血1例救治体会

肝素诱发血小板减少症（heparin-induced thrombocytopenia,HIT）是肝素治疗的严重并发症之一。HIT是血透患者潜在的危及生命的并发症,具有较高的发病率和死亡率[1],日益受到肾内科医师的重视。卫生部颁发的《血液净化标准操作规程（2010版）》也对肝素抗凝的监测等做出了明确的指导。HITI型通常无需特殊处理,继续用药血小板计数回升。     

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…     

手术中应用局部止血药后发生血栓栓塞、急性右心衰竭和弥散性血管内凝血

局部止血药通常用于脊柱外科手术以控制或减少出血。目前市场上有多种局部止血药可选用,我院使用的局部止血药是加入牛凝血酶的可吸收明胶粉剂（Surgifoam^TM）。我们报道一例脊柱侧凸畸形患者进行后路椎体融合矫形术,手术中发生可能是由于血管内误入局部止血药诱发的血栓栓塞,导致急性右心衰竭、心脏停搏以及弥散性血管内凝血（DIC）。临床医生必须警惕局部止血药引起的潜在的致命性并发症。     

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。     

出血、凝血与止血(3)--外科手术并发弥散性血管内凝血

严重创伤和大型手术是引起外科领域中弥散性血管内凝血（ＤＩＣ）的主要原因之一。据上海第二医科大学附属瑞金医院统计１８８例ＤＩＣ的结果,由于创伤和手术诱发者为１６例,占８．４％;另据国内６组ＤＩＣ共６２２例的分析,其中由于创伤和手术引起者为６８例,占１０.９％,日本报道占２．４％。由此可见,创伤和手术所致的ＤＩＣ并非少见,必须引起临床医师的重视。 病因和发病机制 １．创伤 包括挤压综合征、多发性骨折和重度灼伤等。Ｆｅｌｅｓ研究了１８５例创伤和１３５例烧伤患者,发现２５％的创伤和２９％的烧伤患者有肺毛细血…     

重症胆道感染围手术期合并弥散性血管内凝血的诊断和治疗

目的 探讨围手术期重症胆道感染合并DIC的早期诊断和综合治疗的效果.方法 对21例重症胆道感染合并DIC的病人进行综合性治疗,监测治疗前后病人的凝血功能.结果 21例病人中,治愈19例,死亡2例,治愈率90.5%.治疗前与治疗后相比,出血倾向得到控制,腹腔出血停止,病人的凝血酶原时间(PT)明显缩短,纤维蛋白原(Fbg)含量增加,D-二聚体及FDPs水平明显下降.结论 围手术期重症胆道感染病人易合并DIC,且病死率高,早期明确诊断并进行有效的综合性治疗是关键,尤其是冷沉淀联合低分子肝素的应用.     

Computer-assisted orthopedic surgery

 Computer-assisted surgery (CAS) utilizing robotic or image-guided technologies has been introduced into various orthopedic fields. Navigation and robotic systems are the most advanced parts of CAS, and their range of functions and applications is increasing. Surgical navigation is a visualization system that gives positional information about surgical tools or implants relative to a target organ (bone) on a computer display. There are three types of surgical planning that involve navigation systems. One makes use of volumetric images, such as computed tomography, magnetic resonance imaging, or ultrasound echograms. Another makes use of intraoperative fluoroscopic images. The last type makes use of kinetic information about joints or morphometric information about the target bones obtained intraoperatively. Systems that involve these planning methods are called volumetric image-based navigation, fluoroscopic navigation, and imageless navigation, respectively. To overcome the inaccuracy of hand-controlled positioning of surgical tools, three robotic systems have been developed. One type directs a cutting guide block or a drilling guide sleeve, with surgeons sliding a bone saw or a drill bit through the guide instrument to execute a surgical action. Another type constrains the range of movement of a surgical tool held by a robot arm such as ACROBOT. The last type is an active system, such as ROBODOC or CASPAR, which directs a milling device automatically according to preoperative planning. These CAS systems, their potential, and their limitations are reviewed here. Future technologies and future directions of CAS that will help provide improved patient outcomes in a cost-effective manner are also discussed. Received: October 28, 2002 RID="*"     

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors

Objective:This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU).Methods:Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded.Results:The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P  < 0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P  < 0.05).Conclusion:There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality.Level of Evidence:Level IV, Therapeutic Study     

Aortic aneurysm-induced disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) may result in hemorrhagic and thrombotic complications and is rarely associated with stable abdominal aortic aneurysms. In a retrospective review of our experience over the past 5 years, we identified only two instances of DIC-associated abdominal aortic aneurysms among a total of 67 patients who were operated on for asymptomatic aneurysms. In the first patient with DIC induced by abdominal aortic aneurysm, consumptive coagulopathy and a bleeding diathesis developed. The second patient's course was complicated by consumptive coagulopathy and migrating thrombophlebitis. In both instances coagulopathy resolved after surgical intervention. In this report we briefly discuss the pathogenesis and laboratory diagnosis of aneurysm-associated DIC and review current management strategies.     

骨科围手术期监测D-二聚体和同型半胱氨酸的临床意义

[目的]探讨骨科围手术期D-二聚体及同型半胱氨酸的变化对监测深静脉血栓形成的临床意义.[方法]选择55例骨科大手术患者,分别于术前24h,术后24、48、72 h静脉血检测其D-二聚体及同型半胱氨酸的水平,将并发深静脉血栓组与未发生组比较及分别与正常对照组比较,分析它们对监测深静脉血栓形成的早期诊断价值.[结果]手术前24h患者D-二聚体和同型半胱氨酸的浓度,并发深静脉血栓组与未发生组比较结果无显著性差异(P＞0.05),且分别与正常对照组比较差异无显著性(P＞0.05);手术后24、48、72 h,同时间两组比较,并发深静脉血栓组D-二聚体和同型半胱氨酸的浓度明显高于未并发深静脉血栓组,有显著性差异(P＜0.05);并发深静脉血栓组手术后24、48、72hD-二聚体和同型半胱氨酸的浓度与正常组比较,有显著性差异(P＜0.05);未并发深静脉血栓组手术后24hD-二聚体与正常组比较,有显著性差异(P＜0.05),而手术后48、72 h与正常组比较,无显著性差异(P＞0.05);未并发深静脉血栓组手术后24、48、72 h同型半胱氨酸浓度与正常组比较,无显著性差异(P＞0.05);且D-二聚体和同型半胱氨酸血浆浓度升高与手术后深静脉血栓的发生呈显著正相关(P＜0.05);[结论]动态联合监测D-二聚体及同型半胱氨酸的水平对早期诊断骨科大手术后并发深静脉血栓具有重要意义.     

机器人技术在矫形外科中的应用与发展

矫形外科是医疗机器人的重要应用领域,本文综述了典型医疗机器人在矫形外科中的应用与发展,并对机器人技术在矫形外科中所涉及的手术机器人机构、医学图像处理、手术仿真、术中配准、手术安全等关键技术进行了分析,同时指出了今后的发展方向.     

Effect of disseminated intravascular coagulation on donation after citizens’ death donor kidneys

BackgroundTo investigate the effect of disseminated intravascular coagulation (DIC) on donor kidney in donation after citizens’ death (DCD) donors.MethodsThe clinical and laboratory data of 159 DCD donors obtained by our center in 2018 were retrospectively analyzed. The DIC diagnosis was performed according to the Chinese DIC scoring system (CDSS). The donors were divided into two groups: DIC (+) and DIC (−). The difference between kidney rejection rate and zero puncture glomerular microthrombus formation rate were compared.ResultsAmong the 159 DCD donors, 11 were discarded (accounting for 6.91%). The reasons for the discarded cases included 5 cases (3.14%) for moderate and severe glomerular microthrombus formation in the renal zero puncture pathology; 2 cases (1.26%) for glomerular sclerosis ratio over 50%; 2 cases (1.26%) for long-term low blood pressure before pregnancy and significantly increased serum creatinine level and no urine; 1 case (0.73%) for kidney stones and stagnant water; 1 case (0.63%) for malignant tumor. The donor rejection rate of the DIC (+) group was higher than that of the DIC (−) group, and the difference was statistically significant (P<0.05). Among all donors, 10 cases (6.29%) were found to have glomerular microthrombus at zero puncture, and the microthrombotic rate in the DIC (+) group was significantly higher than that in the DIC (−) group (P<0.05). Of the 10 microthrombotic donors, 5 donors with severe glomerular microthrombus were discarded.ConclusionsDonor-induced DIC can easily cause renal glomerular microthrombus formation, and the donor kidney rejection rate has increased.     

Pedal manifestations of disseminated intravascular coagulation.

Disseminated intravascular coagulation is a complex hemostatic imbalance associated with many disease states. The potentially lethal systemic consequences of this disease mandate that the podiatric physician obtain a complete detailed history in addition to proceeding with appropriate consultations from other specialties. If haste is utilized and surgical intervention is undertaken without careful consideration, a potentially fatal situation may ensue. A comprehensive case report highlighting the pedal presentation and complications, and an overview of this disease process are presented.