弥散性血管内凝血高远生.pptVIP

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 第三十一页，共三十七页，2022年，8月28日 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 第三十二页，共三十七页，2022年，8月28日 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 第三十三页，共三十七页，2022年，8月28日 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 第三十四页，共三十七页，2022年，8月28日 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) 第三十五页，共三十七页，2022年，8月28日 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) Sheeh