新鲜冰冻血浆输入量对辅助治疗DIC效果的观察

目的观察不同新鲜冰冻血浆输入量对于辅助治疗弥散性血管内凝血（DIC）的效果。方法内科急诊确诊的37例DIC患者，男31例，女6例；年龄38～79岁，分别输入新鲜冰冻血浆（FFP）200ml（11例），400ml（16例），或600ml（10例），观察血浆输入前后患者D-二聚体（D-D）值的变化。结果3组于输入FFP后12hD-D值均降低，与治疗前比较差异均有统计学意义（均P〈0．05）。600ml组的D-D值下降率为100．00％，显著高于400ml组和200ml组（分别为75．00％和72．73％，均P〈0．05），但200ml组和400ml组间的D-D值下降率间差异无统计学意义（P〉0．05）。结论治疗DIC过程中输入新鲜冰冻血浆有助于降低D-D值，且足量补充比少量输入新鲜冰冻血浆的效果好。     

妊高征并发DIC致多器官功能衰竭的临床分析及护理

目的探讨妊高征并发DIC致多器官功能衰竭的临床发展过程及预后以及治疗策略、护理对策的有关问题。方法回顾分析7例妊高征并发DIC致多器官功能衰竭病例的临床资料。结果领导重视,早期明确诊断及时抢救,加强基础护理和心理护理、合理用药,严密观察病情变化是降低妊高征并DIC致多器官功能衰竭死亡率的关键。     

窒息新生儿凝血功能状态的研究

目的 探讨窒息足月、早产新生儿凝血功能的变化。方法 检测10例正常儿、44例窒息足月儿、32例窒息早产儿凝血指标。结果 与对照组比较，窒息足月儿阴、Am、FIB、PLT无显著差异，D-D明显升高，且与窒息程度正相关。窒息早产儿与窒息足月儿比较阴、Am延长，FIP、PLT降低，D-D无明显差异。结论 窒息足月儿大都存有高凝为特征的前DIC或DIC早期；窒息早产儿更易发生DIC，且有向低凝期发展的趋势。     

化瘀止血法防治急性早幼粒细胞白血病出血和弥漫性血管内凝血疗效观察

目的探讨化瘀止血防治急性早幼粒细胞白血病（APL）出血和弥漫性血管内凝血（DIC）的临床疗效。方法早期采用丹参注射液或川芎嗪注射液，DIC时采用小剂量肝素钠静滴，并间断输注血浆和血小板治疗合并出血的APL62例。结果合并出血38例中8例进展为DIC，32例DIC中31例治愈，无1例出血倾向加重。结论化瘀止血可降低APL DIC的发生率，提高治愈率。     

胎盘早剥31例临床分析

目的：分析胎盘早剥的发病原因及早期诊断治疗.方法：对31例胎盘早剥进行回顾性分析.结果：妊娠期高血压疾病、脐带过短、子宫静脉压突然增高等可能与发生胎盘早剥有关.结论：出现腹痛、阴道出血、血性羊水症状及B超检查有助于胎盘早剥的诊断.     

8例产科DIC患者临床表现及诱因分析

目的:分析产科DIC的临床表现及诱因。方法:回顾性分析我院2004年1月²012年12月间发生的8例产科典型DIC病例的临床资料。结果:①产科DIC主要表现为阴道大出血和休克,多为急性,且病情发展迅猛,不易用原发病解释微循环衰竭或休克,早期发现且及时治疗,预后较好。②诱因明确,如死胎、胎盘早剥、羊水栓塞、产后出血、药物过敏、双胎、肝损、妊娠高血压、HELLP综合征、生殖器感染等;8例孕产妇中死亡1例,子宫切除5例,发生严重后遗症1例,死产3例,死胎2例。结论:由于妊娠后血液、循环系统的特殊变化,孕产妇DIC发生几率升高,应高度重视有发生产科DIC诱因的病例;一旦发生DIC,积极果断地处理是成功救治的关键。     

Persistently Elevated Laboratory Markers of Thrombosis and Fibrinolysis After Clinical Recovery in Malaria Points to Residual and Smouldering Cellular Damage

Screening coagulation tests and assays for thrombosis and fibrinolysis were performed in 80 cases of malaria at presentation and during the course of the disease. Close correlation between the degree of thrombocytopenia (observed in >97% cases) and the presence hemorrhagic manifestations at presentation, and improvement in the platelet count in parallel with clinical recovery emphasised the role of platelets in the pathogenesis of coagulopathy in malaria. A potential selection bias resulting from inclusion of only patients admitted at a tertiary care hospital could explain the higher incidence (27.5%) of clinical bleeding observed in this study compared to that reported in the literature. Although a significant correlation between overt bleeding and abnormal PT/INR and APTT (observed in 20–37% cases) could not be demonstrated, a good correlation existed between normal screening coagulation tests and the absence of bleeding complications. Elevated D-Dimer and FDP levels in almost all cases (90%) of both types of malaria confirmed the high prevalence of disseminated intravascular coagulation and fibrinolysis. A correlation between rising D-Dimer levels and the incidence of bleeding was observed. Follow up studies in six cases with complications showed normalization of platelet counts and of screening coagulation assays with clinical recovery. D-Dimer and FDP levels however, remained elevated in most of these cases indicating the continuation of a smouldering coagulopathy even after full clinical recovery possibly due to the persistence of residual damage to the cells caused by the parasitic infection. Knowledge of this fact is important for avoiding unnecessary investigations and longer hospital stay in patients admitted with malaria.     

Anticoagulant failure in coagulopathic patients: PTT confounding and other pitfalls

Introduction: Devastating thromboses can complicate heparin-induced thrombocytopenia (HIT) and disseminated intravascular coagulation (DIC). In these disorders, acquired abnormalities of the partial thromboplastin time (PTT) and international normalized ratio (INR) can confound monitoring of PTT- and INR-adjusted anticoagulant therapies, contributing to treatment failure.

Areas covered: Illustrative patient cases of anticoagulant failure due to PTT and INR confounding are discussed. Four different scenarios of thrombosis progression associated with inappropriate anticoagulant interruption/underdosing, contributing to ischemic limb necrosis, are presented: i) PTT confounding of heparin therapy of warfarin-associated microthrombosis complicating cancer hypercoagulability; ii) PTT confounding of direct thrombin inhibitor (DTI) therapy complicating HIT-associated DIC; iii) INR confounding during argatroban–warfarin overlap of HIT-associated deep-vein thrombosis; and iv) PTT confounding of anticoagulant therapy during acute DIC/hepatic necrosis–ischemic limb necrosis syndrome.

Expert opinion: Abnormal coagulation test results at pre-treatment baseline can provide an important clue regarding the risk of subsequent anticoagulant failure due to PTT or INR confounding. Greater awareness of the potential for anticoagulant failure due to PTT and INR confounding could assist clinicians in management of prothrombotic coagulopathies, for example, by choosing alternative anticoagulants (e.g., fondaparinux, danaparoid) that are not monitored by global coagulation assays, or by obtaining specific drug levels (anti-factor Xa levels, DTI levels).     

产科急症子宫切除术29例分析

目的分析产科急症子宫切除术的原因、手术时机和手术方式，探讨子宫切除术在产科急症中的应用价值。方法对29例产科急症子宫切除术进行回顾性分析。结果产科急症子宫切除主要原因为：胎盘因素、子宫收缩乏力、妊娠合并症、产科DIC等。手术方式以子宫次全切除为主。结论子宫切除术是抢救产科急、重症出血，降低孕产妇死亡的重要措施。