重度胎盘早剥的处理时限与妊娠结局

目的探讨重度胎盘早剥的诱因、出现症状至分娩的时间与妊娠结局的关系、并发症的处理。方法回顾性分析北京航天总医院2002年1月至2009年12月44例重度胎盘早剥的临床资料。结果主要诱因为妊娠高血压疾病、胎膜早破,并发子宫胎盘卒中27例（61.4%）、休克19例（43.2%）、DIC13例（29.5%）、围产儿死亡23例（52.3%）。27例子宫胎盘卒中自出现症状至分娩时间为6h5min±4h12min;18例失血性休克为6h35min±3h49min;13例DIC为7h2min±4h12min。结论早期诊断及正确处理是减少并发症,降低围产儿死亡率的关键。     

Severe community-acquired pneumonia, shock and multiorgan dysfunction syndrome caused by Chlamydia pneumoniae

Chlamydia pneumoniae has been increasingly recognized as an important aetiological agent in community-acquired pneumonia. A case of severe community-acquired pneumonia and multifunction dysfunction syndrome resulting from Chlamydia pneumoniae infection in a previously healthy adult is presented.     

Elevated plasma tissue factor antigen level in patients with disseminated intravascular coagulation

The plasma tissue factor (TF) antigen level was measured in patients with disseminated intravascular coagulation (DIC). The plasma TF antigen was detected In normal volunteers, and it was significantly higher in DIC patients than in non-DiC patients. However, in some patients with DiC, the plasma TF antigen level was within the normal range. The plasma TF antigen level in patients with DIC significantly decreased after therapy, but it was not correlated with organ failure or outcome. The plasma TF antigen level in patients with DIC was not correlated with other hemostatic markers. The plasma TF antigen level tended to be higher in DIC patients with nonlymphoid leukemia than in those with lymphoid tumor. TF might be implicated in the occurrence and progression of DIC. © 1994 Wiley-Liss, Inc.     

Tissue factor in plasma of patients with disseminated intravascular coagulation

Recently it has been shown that tissue factor (TF), an important trigger for initiating blood coagulation, is present in the circulating plasma. In order to assess the clinical implications of TF in plasma, plasma concentration of TF was quantitated in 65 patients with disseminated intravascular coagulation (DIC). The mean concentration of plasma TF was elevated in patients with DIC at presentation as compared with healthy subjects (446 ± SD 536 pg/ml vs. 138 ± 51 pg/ml, P < 0.001). Abnormally high levels were found only in 46.2% of the patients, predominantly in patients with non-hematological solid tumors and acute leukemia. Plasma TF did not correlate with hemostatic markers of DIC such as thrombinantithrombin III complex, prothrombin fragment 1 + 2, plasmin-α₂-plasmin inhibitor complex, FDP, D-dimer, or fibrinogen. Serial determinations of plasma TF demonstrated that plasma TF changes roughly in parallel with the course of DIC in most patients with elevated TF at presentation of DIC. These findings suggest that plasma TF is potentially valuable for monitoring the progress of DIC in a limited population of patients. © 1994 Wiley-Liss, Inc.     

产后出血死亡9例临床分析

目的：探讨产后出血性休克的病理转归及治疗措施。方法：总结9例产后出血死亡的临床经过，回顾分析死亡原因及治疗措施。结果：产后短时间大量出血，处于严重休克，并发DIC及MSOF时，休克难以纠正。产后或手术后短时间内应用肝素治疗DIC可加剧出血。结论：失血性休克、DIC、MSOF三者的病理生理过程互为因果。快速、准确的监测方法是指导治疗的关键；及时补充血容量是治疗的基本条件；当发生DIC或保守治疗无效时，适时切除子宫以及加强监护，预防和及早治疗MSOF是抢救患者生命的重要措施。     

胎盘早剥合并弥散性血管内凝血的诊治

胎盘早剥是妊娠晚期产科急症之一,并发子宫胎盘卒中、DIC、产后出血、急性肾功能衰竭,严重威胁孕产妇及胎儿的生命安全。胎盘早剥的发生率在国外为1%~2%,国内为0.46%~2.1%,其中胎盘早剥合并弥散性血管内凝血是产科凝血功能障碍最常见原因,一旦发生母儿死亡率极高,且胎盘早剥引起DIC的临床经过及其治疗与其它原因引起的DIC有所不同,所以早期诊断及合理治疗对减少母婴死亡率极其重要。本文就胎盘早剥合并弥散性血管内凝血后的诊断和治疗作一简要综述。     

A case of anorexia nervosa with disseminated intravascular coagulation syndrome

A 36-year-old Japanese woman with anorexia nervosa (AN) was admitted to our department because of severe emaciation. Although we were thorough in her clinical management and were careful to avoid precipitating refeeding syndrome, disseminated intravascular coagulation (DIC) developed 3 weeks after hospitalization. We treated her for DIC with sepsis using anticoagulants, protease inhibitors, antithrombin, and platelet concentrate transfusion. To treat her bacterial infection, we administered antimicrobial drugs and immunoglobulin. We began probiotic and prebiotic (synbiotics) treatment for bacterial translocation. We think that the prevention of sepsis via bacterial translocation is an important aspect of care for patients with severe AN in addition to the prevention of refeeding syndrome.     

Thrombopoietin in Plasmodium falciparum malaria

Thrombopoietin (TPO) is the key growth factor for platelet production and is elevated in states of platelet depletion. As thrombocytopenia is a common finding in malaria, we analysed TPO regulation before, during and after antimalarial treatment. Before treatment, TPO serum levels were significantly higher in patients with severe malaria (n = 35) than in patients with uncomplicated malaria (n = 44; P = 0.024), normalizing within 14-21 d of therapy. The rapid normalization of TPO levels and increase in low peripheral platelet counts after treatment indicate that the biosynthesis of TPO and its regulation in malaria patients are normal.     

Significance of Decreased Plasma D-Dimer Levels following Lipopolysaccharide-Induced Disseminated Intravascular Coagulation in Rats

Plasma D-dimer (DD) is considered to be one of the most useful markers in the diagnosis and assessment of disseminated intravascular coagulation (DIC). The present study was performed to clarify the role of DD in a rat model of lipopolysaccharide (LPS)-induced DIC in which low-molecular-weight heparin (LMWH) and tranexamic acid (TA) were used. We investigated whether a relationship exists between plasma DD levels and severity of DIC. Experimental DIC was induced in rats by a sustained 4-hour infusion of 30 mg/kg LPS administered via the tail vein (LPS group). Rats received either LPS alone (LPS group) or LPS combined with 200 U/kg LMWH (LPS+LMWH group) or 50 mg/kg TA (LPS+TA group) from -30 minutes to 4 hours. Blood was drawn from each rat at 4, 8, and 12 hours. Plasma levels of thrombin-antithrombin complex (TAT) and creatinine were suppressed in the LPS+LMWH group, and less glomerular fibrin deposition was observed compared with the LPS group. On the other hand, an increased level of creatinine and increased glomerular fibrin deposition were observed in the LPS+TA group compared with the LPS group. LMWH demonstrated a protective effect against LPS-induced DIC, resulting in increased survival at 12 hours, whereas TA had the opposite effect. From these results, it appears that LMWH protects against LPS-induced DIC, but TA exacerbates LPS-induced DIC. It was interesting that plasma levels of DD were almost completely suppressed by concurrent administration of either TA or LMWH in this LPS-induced DIC model. This finding suggested that plasma levels of DD were suppressed by inhibition of coagulation (reduced deposition of fibrin) in the LPS+LMWH group and that DD levels were also suppressed by inhibition of fibrinolysis (reduced degradation of fibrin by plasmin) in the LPS+TA group. Thus care should be taken when evaluating the significance of plasma DD levels, because suppressed levels can occur with progressive fibrin deposition and worsening organ dysfunction or improvement in the course of DIC.     

Hämostasestörungen im Umfeld von Sepsis und SIRS

Zum Thema Die h?ufigste Ursache einer disseminierten Gerinnung ist die Sepsis. Sepsis und disseminierte Gerinnung bedingen sich gegenseitig und komplizieren gegenseitig auch den jeweiligen Krankheitsverlauf. Urs?chlich liegen Infektionen, Malignome, Polytrauma, Verbrennungen, Leberversagen, Fruchtwasserembolie, „Dead Fetus Syndrome” und andere Erkrankungen zugrunde. Die Pathogenese der Verbrauchskoagulopathie, bei der es durch reaktive und überschie?ende Aktivierung zum Verbrauch von Gerinnungsfaktoren und -inhibitoren kommt, wird in dieser übersicht aufgezeigt, in der des weiteren die therapeutischen Optionen dargestellt werden. Die wichtigste davon dürfte die Substitution von Antithrombin III sein, die sich im septischen Schock bew?hrt hat.