创伤导致弥漫性血管内凝血四例临床探究及研究.doc

创伤导致弥漫性血管内凝血四例临床探究及研究【摘 要】 目的 早期及时的诊断和正确的治疗创伤导致的弥漫性血管内凝血 (DIC),以减少误诊及死亡率,提高治愈率。方法 回顾性研究我院骨科2005～2007年内创伤导致的DIC 4例患者的一般状况及其基础疾病、诊断和治疗、转归情况。结果 创伤导致的DIC,主要是与创伤后血容量不足,大量的凝血因子丢失有关。4例患者均得到早期良好的治疗,其成功率为100%。结论 创伤导致的DIC一经确诊就要尽早治疗,早期治疗可以明显降低死亡率,提高治愈率,治疗关键是祛除原发病,按照缺什么补什么的原则并给予肝素化治疗。晚期以纤溶为主,有严重出血倾向,方可抗纤溶治疗。 【关键词】 创伤;DIC诊断;肝素治疗;血小板;抗纤溶 【Abstract】 Objective To improve the early diagnosis and treatment of DIC caused by trauma,so as to reduce misdiagnosis and death rate, and raise recovery rate. Methods Data of four cases of DIC caused by trauma in department of osteology from 2005 to 2007 including general condition and basic disease, diagnosis and treatment, prognosis etc. were studied retrospectively. Results DIC caused by trauma was related to hypovolemia after trauma and a lot of blood coagulation factors loosing. Four patients was received early favorable treatment with a successful rate of 100%.Conclusion DIC caused by trauma should be treated as soon as possible. Early treatment can obviously reduce death rate and improve recovery rate. The key point of treatment is to eliminate primary disease and implement heparin therapy according to the principle of “supplementing what is deficient”. Fibrinolysis is the main therapy in advanced stage.Antiplasmin may be used only for patients with hemorrhagic tendency. 【Key words】 Trauma;DIC diagnosis;Heparin therapy;Platelet;Antiplasmin 弥漫性血管内凝血(disseminated intravascular coagulation,DIC)是临床各科均可发生的一种全身性血栓――出血综合征,它是在原发病的基础上,血管内皮受损,凝血系统激活凝血亢进而导致微血管内广泛的微血栓形成,凝血因子的消耗、纤维溶解亢进、血小板功能障碍引起全身广泛性出血,同时血栓栓塞引起全身脏器供血不足而导致多器官的功能衰竭,如果临床不能及时作出诊断及正确的治疗死亡率很高,但是如何正确的诊断,恰当的治疗仍然是临床上的难题,现将我院骨科2005～2007年抢救4例患者成功的经验总结分析如下。 1资料与方法 1.1临床资料2005年5月～2007年11月,我科救治创伤后发生DIC者4例,其中男性2例,女性2例;年龄35～47岁,平均年龄42岁;发生时间伤后2～5 h。发生前均有大量的失血,2例为多发性骨折所导致,1例是身体重要血管损伤所致。 1.2实验室检查血小板计数(20～90)×109/L,平均 55×109/L;血纤维蛋白定量为0.2～1.5 g/L,平均1.08 g/L;凝血酶原时间较正常延长3～20 s,平均18.5 s。3P实验4例阳性。所有病例均符合DIC诊断标准 1.3临床表现4例均有不同程度失血性休克的表现,且全身均有熟玉米味。1例重者血压测不到,3例轻者血压也在12.0/4.7 kPa以下,重者意识模糊昏