第八章北医病理学课件dic.pptVIP

失代偿型：凝血因子和血小板消耗占优势，数量减少；临床表现：出血、休克；多见于急性型DIC。 代偿型：凝血因子和血小板的生成和消耗基本平衡，临床表现不明显或轻微；多见于轻度DIC。 过度代偿型：凝血因子和血小板生成超过消耗；临床表现不明显；多见于慢性或恢复期DIC。 各型DIC的特征 Characteristics of Different DIC Types Platelet count: Markedly decreased Prothrombin time: Increased Activated partial thromboplastin time: Increased Fibrin degradation products: Markedly increased Fibrinogen: Normal or decreased Antithrombin III: Markedly decreased Protein C: Markedly decreased Laboratory Findings in DIC 问题： DIC的分期与特点? DIC的分型? A 56-year-old man was admitted to the emergency department after a car accident. He had several bone fractures, a cerebral contusion, and hemodynamic instability caused by a ruptured spleen. Emergency splenectomy and aggressive administration of fluids restored hemodynamic stability, and the patient was transferred to the intensive care unit (ICU). A few hours later, profuse extravasation was noted from the abdominal drains, endotracheal tube, and puncture sites of all intravascular lines. Clinical Case Laboratory tests showed a rapidly falling hemoglobin level and a platelet count of 25,000/μL (normal150,000/μL). The activated partial thromboplastin time (aPTT) was 44 sec (normal, 28), prothrombin time (PT) was 29 sec (normal, 12.5). The level of fibrinogen degradation products was 360-520 g/L (normal, 40) and the plasma antithrombin III level was 28% (normal, 80-120). Clinical Case Based on these findings, the diagnosis was DIC secondary to severe trauma. Surgical exploration revealed diffuse oozing of blood at the site of the operation, but only partial surgical hemostasis could be achieved. The patient was given supportive treatment with large infusions of fresh plasma and platelet concentrates. The bleeding stopped 48 hours later. Coagulation parameters eventually returned to normal and the subsequent clinical course was uneventful. Clinical Case DIC治疗的病理生理基础 Pathophysiological Basis of DIC Treatment 1. 积极防治原发病 2. 早期发现、及时治疗 保护重要脏器功能 抗凝治疗 补充凝血物质 适当的抗纤溶