弥散性血管内凝血(高远生).ppt

Laboratory tests showed a rapidly falling hemoglobin level and a platelet count of 25,000/μL (normal150，000/μL). The 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 抗凝治疗 保护重要脏器功能 补充凝血物质 适当的抗纤溶治疗 Vocabulary disseminated intravascular coagulation (DIC;弥散性血管内凝血) prothrombin (凝血酶原), thrombin (凝血酶) fibrinogen (纤维蛋白原)，fibrin (纤维蛋白)， tissue factor pathway inhibitor (组织因子途径抑制物) protein C system (蛋白C系统) thrombinmodulin (血栓调节蛋白) antithrombin Ⅲ (抗凝血酶Ⅲ) Vocabulary tissue plasminogen activator (t-PA；组织纤溶酶原激活物) plasminogen (纤溶酶原)，plasmin (纤溶酶), fibrinolysis (纤维蛋白溶解) fibrin degradation products(FDP, 纤维蛋白降解产物) Waterhouse syndrome (华-佛综合征) Sheehan syndrome (席-汉综合征) microangiopathic hemolytic anemia (微血管病性溶血性贫血) schistocyte (裂体细胞) Thanks! 谢谢！ Common causes of DIC. 感染性疾病细菌感染败血症、内毒素血症、病毒性肝炎、流行性出血热 广泛组织损伤大面积挫伤或烧伤、挤压综合症、大手术、器官移植 产科意外胎盘早剥、羊水栓塞、宫内死胎、妊娠中毒症、流产术 恶性实质肿瘤肺、消化系及泌尿系癌、转移癌、恶性葡萄胎、绒毛膜上皮癌 急性白血病急性早幼粒白血病 其他疾病内毒素休克、严重出血或过敏性休克、大面积心肌梗死、异型输血、巨大海棉状血管瘤、肾小球肾炎、类风湿关节炎、系统性红斑狼疮、肾移植排斥反应 外源性凝血系统: 15 seconds;内源性凝血系统, 1-6 min Clotting factors from livers: I, II, V, VII, IX, X, XI, XII, XIII From Platelet: III, IV(Ca2+), VIII, XIII From endothelial cells: VIII 高分子激肽原, 前激肽释放酶 are synthesized in the liver VIIIa increase the speed of the reaction from X to Xa 200,000-fold faste