弥散性血管内凝血诊治进展

弥散性血管内凝血(DIC)是在某些严重疾病基础上,由特定诱因引发的复杂病理过程.致病因素引起人体凝血系统激活、血小板活化、纤维蛋白沉积,导致弥散性血管内微血栓形成;继之消耗性降低多种凝血因子和血小板;在凝血系统激活的同时,纤溶系统亦可激活,或因凝血启动而致纤溶激活,导致纤溶亢进.临床上以出血、栓塞、微循环障碍和微血管病性溶血等为突出表现[1-2].     

产科相关弥散性血管内凝血如何诊断和处理

产科相关弥散性血管内凝血(DIC)是孕产妇死亡的主要原因之一,往往进展迅速,诊断困难,需引起临床医生高度重视.由于妊娠期生理性高凝状态,产科相关DIC诊断需要结合临床表现、妊娠校正的DIC评分和反复的实验室检查结果.如DIC合并产科大出血,优先考虑止血治疗,必要时需手术及大量的血制品替代,充分评估后谨慎使用抗凝或促凝药...     

弥散性血管内凝血诊断标准：问题与期望

弥散性血管内凝血（disseminated intravascular coagulation,DIC）的发生机制复杂,致病因素不同,其对应的病理 生理机制及临床特点也存在很大差异,DIC的诊断是目前临床存在的一个难题。虽然现存很多DIC诊断标准,但是 各自存在一定的局限性,目前仍缺乏DIC诊断的金标准。因此文章将从DIC提出的背景、DIC诊断标准及评价、DIC 诊断标准对于COVID-19导致的凝血功能障碍是否适用以及对DIC诊断标准的未来期望做一评述。     

弥散性血管内凝血治疗指南

概述 弥散性血管内凝血（DIC）治疗的关键是通过强有力的手段治疗原发病,在许多DIC患者,通过恰当地治疗原发病,DIC将自然痊愈。例如,对伴DIC的严重感染和脓毒症患者,可使用抗菌药物及（或）外科引流。但在某些患者,     

产科弥散性血管内凝血9例分析

产科弥散性血管内凝血 (DIC)起病急、进展快 ,严重威胁母婴生命安全。若能早期诊断、恰当处理 ,可显著改善预后。1995年 1月至 2 0 0 1年 12月 ,我院曾收治产科DIC 9例 ,成功抢救 8例 ,死亡 1例。现报告如下。临床资料 :本组患者年龄 2 3 3 7岁。初产妇 5例 ,经产妇4例。均发生在妊娠晚期 ,产前发病 2例 ,产后发病 7例。本组 9例均按 1989年全国血液病学会制定的DIC诊断标准确诊 :①存在易引起DIC的病因 ,②有多发性出血倾向 ,末梢循环衰竭或微血管栓塞等表现 ,③实验室凝血功能检查有三项以上异常。本组DIC产生原因与治疗转归详见表 …     

前弥散性血管内凝血患者凝血与纤溶的研究

前弥散性血管内凝血(DIC)是一种存在易于发生DIC基础疾病，有可疑DIC临床表现及某些实验异常，但尚未发现典型DIC临床症状及体征，或尚未达到DIC诊断标准的一种亚临床状态或血栓前状态。加强对前DIC的研究，对DIC的早期防治具有重要意义。本研究通过常规凝血试验、凝血及纤溶分子标记物凝血酶原片段1 2(F1 2)、凝血酶一抗凝血酶复合物(TAT)、n二聚体(D-D)检测，探讨前DIC凝血与纤溶的变化，指导前DIC的诊断与治疗。     

恶性肿瘤并发弥散性血管内凝血30例分析

弥散性血管内凝血 (DIC)是恶性肿瘤患者的严重并发症 ,常危及生命。现将我院 2 0 0 2年 1月～2 0 0 3年 12月收治的恶性肿瘤并发DIC 30例进行回顾性分析 ,探讨其诊治及预防措施。资料与方法一般资料　 30例患者 (男 2 1、女 9) ,年龄 4 0～70岁 ,平均 5 6 .8岁。其中肺癌 8例、原发病灶不明骨转移癌 2例、卵巢癌 3例、淋巴瘤 4例、胃癌 5例、肾癌 2例、肝癌 2例、急性淋巴细胞白血病 2例、急性早幼粒细胞白血病 2例。诊断时所有实体瘤临床分期均为中、晚期。30例并发DIC者占同期恶性肿瘤中、晚期住院患者的 6 .35 %。临床表现　 30例并…     

重症监护病房中弥散性血管内凝血的预测

弥散性血管内凝血(disseminated intravascular coagula- tion,DIC)在重症监护病房中相当常见。与DIC相关的典型的临床基础疾病有：脓毒血症(sepsis)或其他严重感染;器官损伤如重症胰腺炎或创伤;恶性肿瘤,特别是骨髓增殖性和淋巴增生性肿瘤,也包括腺癌;产科并发症,如羊水栓塞、胎盘早剥;血管疾病,如血管瘤-血小板减少综合征(卡一梅综合征)、巨大动脉瘤;严重的肝功能衰竭;各种中毒和免疫反应,如严重的抗磷脂[抗体]综合征、输血反应、移植排斥反应、肝     

弥散性血管内凝血35例的临床分析

目的 探讨急性弥散性血管内凝血(DIC)患者的临床特点、诊断及救治经验.方法 回顾性分析2007-01～2010-05 35例DIC患者的原发病因、临床表现及实验室检查.结果 22例抢救成功,13例患者死亡.不同原发病的患者发生DIC的临床表现不同.结论 处理原发病因是抢救成功的关键,密切观察DIC诊断指标,早发现、早治疗,对患者的综合治疗十分重要.     

胃癌并发弥散性血管内凝血1例诊治教训

患者,女,52岁,无业。以间断腰痛1周,血尿5d入院。患者于10月1日起病,无明显诱因出现左侧腰部疼痛,呈持续性胀痛,无恶寒、发热、尿急、尿痛。10月2日出现全程肉眼血尿,至某医院门诊,给予止血芳酸、安络血、头孢素等治疗,血尿无     

The diagnosis of disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation. In recent years, the pathogenetic pathways leading to DIC have been largely identified, which could result in more precise diagnostic tests for this disorder. However, the clinical and laboratory diagnosis of DIC may remain difficult, since routinely available tests do not specifically assess ongoing thrombin generation. Molecular markers for activation of coagulation and fibrinogen to fibrin conversion are highly sensitive but also disappointedly aspecific for the diagnosis of DIC. Moreover, these tests are often not available in most settings for daily clinical care. A combination of widely available tests, however, may be helpful in making the diagnosis of DIC, according to a recently developed algorithm.     

弥散性血管内凝血前期诊断

根据有导致弥散性血管内凝血 (ＤＩＣ)的原发疾病的存在 ,临床上有出血症状和多系统脏器功能障碍 (ＭＯＦ) ,加之实验室指标有血小板进行性减少、纤维蛋白原 (Ｆｇ)减少、纤维蛋白 (原 )降解产物(ＦＤＰ)增高、3Ｐ试验阳性或 (和 )Ｄ -二聚体阳性 ,这种典型的ＤＩＣ诊断并不困难。但这时ＤＩＣ已经发展到了中晚期。因此 ,建立ＤＩＣ前期 (Ｐｒｅ -ＤＩＣ)的概念 ,在治疗原发疾患、抑制由原发疾患产生的ＤＩＣ诱发物质的同时 ,早期发现ＤＩＣ ,预防和控制ＤＩＣ向严重阶段进展 ,对预后起着非常重要的作用。1　ＤＩＣ诊断所存在的问题　　由于…     

The diagnosis and management of disseminated intravascular coagulation

This review describes disseminated intravascular coagulation (DIC) as a syndrome in which hemostatic factors are activated. The syndrome ranges in severity from a decompensated coagulopathy (overt-DIC) to the subclinical compensated activation of hemostatic factors (nonovert DIC). The first part of this review emphasizes two points. First, activation of the hemostatic system is controlled by a vast network of capillaries and venules through anticoagulant and anti-inflammatory regulatory factors that operate from the endothelium (e.g., protein C and thrombomodulin, tissue factor pathway inhibitor). These hemostatic regulators can be overridden by procoagulant disorders such as amniotic fluid embolism or degraded by proinflammatory disorders such as sepsis. Second, because this link between the microvascular endothelium and circulating hemostatic factors is so close, even a relatively mild disturbance of the microvasculature targeted by the inflammatory process may be reflected systemically by changes in molecular biomarkers of hemostatic activity. Therefore, application of criteria for the diagnosis of nonovert DIC should be of value in detecting a compensated response to inflammatory stress of the microvasculature in patients who are at risk before they develop an uncompensated over DIC response and organ failure. The second part of this review covers the recent experience investigators have had in diagnosing and following the response of patients to treatment with biomarkers.     

弥散性血管内凝血的诊断和鉴别诊断

临床诊断弥散性血管内凝血 (ＤＩＣ)需符合下列条件 :①存在易致ＤＩＣ的基础疾病 ;②有ＤＩＣ的临床表现 ;③有符合ＤＩＣ实验诊断的指标 ;④抗凝治疗有效。然而 ,ＤＩＣ需与原发性纤溶症、肝病出血等作鉴别诊断。本文就此作一简述。1　ＤＩＣ的诊断1 1　易致ＤＩＣ的基础疾病[1] 　ＤＩＣ定有基础疾病所引起 ,常见的基础疾病有 :　　 ( 1)感染性疾病 ( 2 5%～ 4 0 % ) :可分为细菌性感染 :革兰阴性菌败血症 ;脑膜炎双球菌、大肠杆菌、绿脓杆菌、沙门菌属等感染 ;革兰阳性菌败血症 ;肺炎球菌、金黄色葡萄球菌、溶血性链球菌等感染。病毒感…     

医源性弥散性血管内凝血

弥散性血管内凝血 (ＤＩＣ)是一种临床较为常见的病理综合征。临床报告中以继发于感染、恶性肿瘤、病理产科及创伤者多见 ,但近年来 ,因医疗处理 (包括药物 )及医疗操作所导致的ＤＩＣ逐渐引起人们的重视。报道和发现的可能诱发ＤＩＣ的药物已达几十种。在引起ＤＩＣ的病因及诱发因素中 ,医源性因素仅次于感染性疾病及恶性肿瘤而居第 3位。因此有关医源性因素诱发或激发的ＤＩＣ应引起临床医师的足够重视 ,以便在临床上能正确认识、鉴别、诊断该疾病 ,减少临床可能出现的不良后果。1　病因　　医源性ＤＩＣ的概念是 1978年日本学者首先提出…     

Treatment of disseminated intravascular coagulation

Early diagnosis and immediate treatment of the disease responsible for DIC are most important for successful therapy of DIC. Furthermore, it is also necessary to use anticoagulant agents in most cases of DIC. The agents may be classified on the basis of their mode of anticoagulant action into three groups: ones with antithrombin effect, ones with anti-Xa effect or ones with both effect, and each agent is hoped to be chosen appropriately for development of DIC in near future. At present, such anticoagulant agents as standard heparin, antithrombin-III concentrate, gabexate mesilate, nafamostat mesilate, MD-805, low molecular weight heparin, heparan sulfate, activated protein C, are known as drugs for DIC, and each of them was effective for improvement from DIC in our experience. Antifibrinolytic agents, which have been considered to be contraindicated for therapy of DIC, may be good indication for selected cases of DIC with enhanced fibrinolysis such cases as acute promyelocytic leukemia. Antiplatelet agents may be available for some cases of chronic DIC.