成人急性白血病合并弥散性血管内凝血36例临床分析

目的 探讨急性白血病合并弥散性血管内凝血（DIC）的临床特点及疗效.方法 分析36例急性白血病病人的临床资料,观察常规DIC筛查指标,以及小剂量肝素钠治疗效果.结果 152例初治的急性白血病人中36例（23.68%）合并DIC,8例病人死亡,5/8人死于颅内出血.DIC病人与非DIC病人PT、Fbg、TT、PLT均数比较差异显著（P＜0.01）,D-dimer、PT、Fbg异常阳性率达80%以上.应用小剂量肝素钠联合血小板输注及凝血因子补充治疗,DIC治愈率77.78%,治愈率病人的DIC纠正时间为7～15 d（均值9.32±5.10）.结论 DIC是急性白血病常见及严重并发症,PT、Fbg、TT、D-dimer是白血病合并DIC重要观察指标,小剂量肝素钠可以有效治疗急性白血病合并DIC.

36 Cases Disseminated Intravascular Coagulation(DIC) in Adult Patients with Acute Leukaemia.

Objective In order to observe the treatment result of acute leukemia patients with DIC . Methods reviewed 36 cases of disseminated intravascular coagulation （ DIC ） at presentation of previously untreated adults with acute leukemia. , treated all patients with DIC by using low doses of heparin with platelet or cryoprecipitate transfusions . Results DIC was diagnosed in 36 of 152 （23.68%） acute leukemia patients before initiation of chemotherapy . There were 8 patients with DIC died , and 5 of 8 patients died with central nervous system （CNS） The others with DIC recovered after 7 -15 days treatment（ average is 9.32±5.10 ）. 77.78% leukemia patients with DIC could recovered from DIC. D-dimer, PT,Fbg positive rate were over 80%. The average of PT,Fbg,TF and PLT were significant different between DIC patients and patients having no DIC. Conclusion DIC at presentation was associated with a significantly increased risk for severe CNS haemorrhagic complications. D-dimer,PT,Fbg were sensitive indicators for DIC diagnosis in leukemia . Low doses of heparin , with platelet or cryoprecipitate transfusions were effective for DIC patients with leukemia.