危重病患者并发弥散性血管内凝血的诊治  

Diagnosis and Treatment of Disseminated Intravascular Coagulation in Critically Ill Patients

作　　者：杨锐[1] 魏莱[1] 洪梅[1] 杨焰[1] 魏文宁[1] 胡豫[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院,武汉430022

出　　处：《血栓与止血学》2009年第5期216-218,共3页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探讨危重病患者并发弥散性血管内凝血(DIC)的临床表现及有效治疗措施。方法对我院2005年1月至2006年5月危重病并发DIC患者的临床表现及治疗措施进行回顾性分析和总结;用免疫法、发色底物法和凝固法分别测定36例危重病并发DIC患者血浆D二聚体(D-dimer,D-D)、抗凝血酶活性(AT:A)、凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)、纤维蛋白原含量(Fbg)等凝血及抗凝指标。结果本组36例危重病患者并发DIC,治愈15例,好转9例,死亡12例;DIC患者的各项指标与正常对照组间差异有统计学意义,特别是D-D含量明显增高,AT:A明显减低,差异具有显著性意义(P<0.01),其中AT:A检测具有较高的阳性率(94.4%),且12例死亡病例均发生明显减低(阳性率达100%)。结论危重病患者DIC发生率高,死亡率高。治疗关键是祛除原发病,密切观察早期DIC诊断指标,早发现、早治疗。对危重病患者的早期综合治疗至关重要。Objective To study the clinical change disseminated intravaseular coagulation （DIC）. Methods and effective treatment in critically ill patients with The chang and effective treatment in critically ill patients with DIC in our hospital from January 2006 to May 2004 were retrospectively analyzed;and plasm lever of D- Dimer, antithrombin activity （ AT ： A）, prothrombin time （ PT）, activated partial thromboplastin time （aPTT） ,thrombin time（TT） and fibrinogen（Fbg） of 36 critically ill patients with DIC were tested by immunoological,color substrate and coagulation method. Results In 36 patients with DIC, 15 patients were cured,9 patients improved, 12 patients died. The levers of these parameters were significantly different between the DIC and the normal group. Especially D- Dimer increased and AT：A decreased （P 〈0.01 ）. Sensitivities of AT：A in the group of patients was higher（94.4% ） and all decreased in 12 critically ill patients with DIC whom were died . Conclusion Because of the high incidence and mortality in critically ill patients with DIC. The most important therapy is to eliminate the inducement, early detecting DIC routine examination, early treating, it is very important to manage the critically ill patients with DIC through integrated therapy.

关 键 词：弥散性血管内凝血 抗凝血酶活性 D二聚体 

分 类 号：R554[医药卫生—血液循环系统疾病]