同种异体器官移植合并急性弥散性血管内凝血出血六例治疗分析  

Therapeutic effect and initial experience of 6 organ transplant recipients with acute disseminated intravascular coagulation hemorrhage

作　　者：李涛 蒋鸿涛 徐剑 曾凡军 任坤 何松哲 王利霞 蔡扬柏 陈良杰 王毅[1,2] LI Tao;JIANG Hongtao;XU Jian(Department of Organ Transplantation,the Second Affiliated Hospital of Hainan Medical University,Hainan,Haikou 570105,China;不详)

机构地区：[1]海南医学院第二附属医院器官移植科,海口570105 [2]海南医学院器官移植研究所

出　　处：《临床外科杂志》2021年第8期774-778,共5页Journal of Clinical Surgery

基　　金：海南省科技厅重大科技计划项目(ZDKT2019009);海南省教育厅研究生创新科研课题(Hyb2020-59);院内科研项目启动基金(KYQDJ-2018-02)。

摘　　要：目的探讨器官移植受者发生弥散性血管内凝血(disseminated intravascular coagulation,DIC)的临床特点和防治策略。方法回顾性分析2019年8月~2020年8月接受器官移植后发生急性DIC出血的6例受者的临床资料、DIC治疗方案和术后的相关检测指标。结果 6例受者在手术当天凝血功能及血小板均异常,根据国际血栓与止血委员会的DIC评分表诊断为急性DIC。术中予以早期、快速、大量输注凝血物质及血小板后,DIC被纠正,术后1周内凝血功能基本恢复正常。移植物功能在术后1周基本恢复正常,1例肾移植受者发生肾功能延长恢复。结论器官移植受者发生DIC的原因复杂、凶险,可能与高群体反应性抗体(PRA)与术前凝血功能异常有关;术中早期、快速、大量的输注凝血物质和血小板是纠正急性DIC出血的关键;器官移植受者术中发生急性DIC出血后,若能及时纠正,并保证移植物术中的血流灌注,其对移植物功能的早期恢复并无明显影响。Objective To investigate the clinical characteristics and prevention strategies of acute disseminated intravascular coagulation( DIC) hemorrhage which happened in organ transplant recipients. Methods The clinical data,DIC treatment strategy,test indicators of 6 patients who underwent organ transplantation between August 2019 and August 2020 with acute DIC hemorrhage,were retrospectively analyzed. Results The coagulation function and platelets of 6 patients were abnormal on the day of surgery,and were diagnosed as acute DIC according to the DIC rating scale of the International Society of Thrombosis and Stasis( ISTH). DIC was corrected after early. Rapid and massive infusion of clotting substances and platelets during operation,and the coagulation function basically returned to normal within 1 week after the operation as well as graft function,except for DGF in 1 renal transplant recipient.Conclusion The cause of DIC in organ transplant recipients are complex and dangerous,which may be related to high PRA and abnormal coagulation function before operation;Early,rapid and massive intraoperative infusion of clotting substances and platelets is the key to correct acute hemorrhagic DIC;After the occurrence of actue DIC hemorrhage in organ transplant recipients,the early recovery of graft function is not affected,provided that blood perfusion during the operation is necssary.

关 键 词：器官移植 急性DIC出血 凝血物质 

分 类 号：R617[医药卫生—外科学] R554.8[医药卫生—临床医学]