ZhaoMingyaoBMC.ZZU.ppt

* * (一)积极防治原发病（Prevention and Treatment of Primary Disease） 预防和迅速治疗可引起DIC的原发病，是防治DIC的首要关键。 （二）早期发现、及时治疗(Early Diagnosis and Timely Treatment) 对急性全身性DIC，病情变化迅速凶险，故早期发现，及时合理治疗是提高DIC治愈率的另一关键环节。 1．抗凝治疗(Anticoagulation therapy) DIC的根本发病机制是凝血亢进，使用肝素、antithrombin Ⅲ等抗凝剂，阻断DIC凝血亢进的恶性环节，是DIC治疗的首要措施。但应特别注意，抗凝剂不足不能有效阻断凝血亢进，而过量会加重出血，故合适的抗凝剂量是治疗的关键。 2．保护重要脏器功能(Protection of organs function) Multiple organ dysfunction常是DIC导致死亡的主要原因，故保护各重要脏器功能十分重要。应及时防治shock、纠正内环境紊乱，对出现的脏器功能障碍给予积极纠正。 3．补充凝血物质（Supplement of coagulating substances） 当体内凝血物质严重降低时，适量补充新鲜血浆或全血、浓缩血小板血浆和各种凝血因子制剂，有助于纠正体内的凝血功能失常，减轻出血。应特别注意补充凝血物质必须在有效抗凝的基础上进行，否则反会促进microthrombosis。 4.适当的抗纤溶治疗(Antifibrinolytic therapy) 一般DIC不应使用抗纤溶治疗。若DIC患者体内存在原发性纤溶亢进时，如早幼粒白血病等，可考虑适量的抗纤溶治疗，有助于减轻出血。 DIC治疗的病理生理基础 * * Dhainaut JF, et al. J Thromb Haemost 2004;2:1924-33 Disseminated intravascular coagulation (DIC) is a serious condition associated with sepsis. Clinical management of DIC is hampered by lack of clear diagnostic criteria. The International Society on Thrombosis and Haemostasis (ISTH) has proposed a diagnostic scoring algorithm for overt DIC based on routine laboratory tests. The objective was to assess a modified version of the ISTH scoring system and determine the effect of drotrecogin alfa (activated) (DrotAA, recombinant human activated protein C) on patients with DIC. The large database from the PROWESS clinical trial in severe sepsis was retrospectively used to assess a modified ISTH scoring system. Baseline characteristics and treatment effects of DrotAA were evaluated. At baseline, 29% (454/1568) of patients had overt DIC. Overt DIC was a strong predictor of mortality, independent of APACHE II score and age. Placebo-treated patients with overt DIC had higher mortality than patients without (43 vs. 27%). DrotAA-treated patients with overt DIC had a trend towards greater relative risk reduction in mortality than patients without (29 vs. 18%, P = 0.261) but both groups had greater relative risk reduction than placebo-trea