弥散性血管内凝血患者的临床特征分析

被引：12

作者：

杨婷

高清平

机构：

[1] 武汉大学人民医院

来源：

内科急危重症杂志 | 2016年 / 22卷 / 03期

关键词：

弥散性血管内凝血; ISTH显性积分; 止凝血指标;

D O I：

暂无

中图分类号：

R554.8 [];

学科分类号：

摘要：

目的:探讨弥散性血管内凝血(DIC)患者的临床表现、诊断、治疗及预后特征。方法:回顾性分析我院按ISTH评分诊断的928例DIC患者的临床资料,包括原发病、临床表现、止凝血指标、治疗及预后等。结果:377例(40.63%)出现不同程度出血,353例(38.04%)出现休克,523例(56.36%)出现器官衰竭。感染占DIC原发病比例最高(44.40%),感染并发DIC器官衰竭发生率最高(62.62%);病理产科DIC出血率最高(76.92%),休克率最高(73.08%),有效率最高(65.38%),病死率最低(0.00%);恶性肿瘤DIC病死率最高(35.88%),与总计发生率相比差异显著(均P<0.05)。有效组和无效组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及D-二聚体比较差异显著(均P<0.05),纤维蛋白原浓度(FIB)及血小板(PLT)最低值比较差异不显著(均P>0.05)。PLT下降率越高,DIC患者有效率越低;ISTH显性积分越高,DIC患者有效率越低(均P<0.05)。结论:出血是DIC典型的临床表现,器官衰竭更为常见;感染占DIC原发病比例最高,感染并发DIC器官衰竭发生率最高,病理产科DIC出血及休克发生率最高但预后最好,恶性肿瘤DIC预后最差;PT、APTT、D-二聚体、PLT下降率及ISTH显性积分有助于提示DIC患者的预后。

引用

页码：194 / 198

页数：5

共 17 条

[1]

显性DIC评分对40例脓毒血症患者预后的评估 [J].

侯著法 ;

向诗非 ;

张晓华 .

内科急危重症杂志, 2006, (06) :280-281

[2]

Asphyxia by Drowning Induces Massive Bleeding Due To Hyperfibrinolytic Disseminated Intravascular Coagulation [J].

Schwameis, Michael ;

Schober, Andreas ;

Schoergenhofer, Christian ;

Sperr, Wolfgang Reinhard ;

Schoechl, Herbert ;

Janata-Schwatczek, Karin ;

Kuerkciyan, Erol Istepan ;

Sterz, Fritz ;

Jilma, Bernd .

CRITICAL CARE MEDICINE, 2015, 43 (11) :2394-2402

[3]

Anticoagulant therapy for sepsis-associated disseminated intravascular coagulation: the view from Japan [J].

Iba, T. ;

Gando, S. ;

Thachil, J. .

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2014, 12 (07) :1010-1019

[4]

Disseminated intravascular coagulation: Testing and diagnosis.[J].Hideo Wada;Takeshi Matsumoto;Yoshiki Yamashita;Tsuyoshi Hatada.Clinica Chimica Acta.2014,

[5]

Diagnostic possibilities of specific fibrin(ogen) degradation products in relation to venous thromboembolism [J].

Haas, Fred J. L. M. ;

Schutgens, Roger E. G. ;

Biesma, Douwe H. ;

Laterveer, Ria H. ;

Kluft, Cornelis .

BLOOD COAGULATION & FIBRINOLYSIS, 2013, 24 (03) :297-304

[6]

Disseminated intravascular coagulation: a review for the internist [J].

Levi, Marcel ;

van der Poll, Tom .

INTERNAL AND EMERGENCY MEDICINE, 2013, 8 (01) :23-32

[7]

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 [J].

Dellinger, R. P. ;

Levy, Mitchell M. ;

Rhodes, Andrew ;

Annane, Djillali ;

Gerlach, Herwig ;

Opal, Steven M. ;

Sevransky, Jonathan E. ;

Sprung, Charles L. ;

Douglas, Ivor S. ;

Jaeschke, Roman ;

Osborn, Tiffany M. ;

Nunnally, Mark E. ;

Townsend, Sean R. ;

Reinhart, Konrad ;

Kleinpell, Ruth M. ;

Angus, Derek C. ;

Deutschman, Clifford S. ;

Machado, Flavia R. ;

Rubenfeld, Gordon D. ;

Webb, Steven ;

Beale, Richard J. ;

Vincent, Jean-Louis ;

Moreno, Rui .

INTENSIVE CARE MEDICINE, 2013, 39 (02) :165-228

[8]

Prospective evaluation of hemostatic abnormalities in overt DIC due to various underlying diseases [J].

Kawasugi, Kazuo ;

Wada, Hideo ;

Hatada, Tsuyoshi ;

Okamoto, Kohji ;

Uchiyama, Toshimasa ;

Kushimoto, Shigeki ;

Seki, Yoshinobu ;

Okamura, Takashi ;

Nobori, Tsutomu .

THROMBOSIS RESEARCH, 2011, 128 (02) :186-190

[9]

Frequency and hemostatic abnormalities in pre-DIC patients [J].

Okamoto, Kohji ;

Wada, Hideo ;

Hatada, Tsuyoshi ;

Uchiyama, Toshimasa ;

Kawasugi, Kazuo ;

Mayumi, Toshihiko ;

Gando, Satoshi ;

Kushimoto, Shigeki ;

Seki, Yoshinobu ;

Madoiwa, Seiji ;

Asakura, Hidesaku ;

Koga, Shin ;

Iba, Toshiaki ;

Maruyama, Ikuro .

THROMBOSIS RESEARCH, 2010, 126 (01) :74-78

[10]

A multicenter; prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: Comparing current criteria*.[J].Satoshi Gando;Toshiaki Iba;Yutaka Eguchi;Yasuhiro Ohtomo;Kohji Okamoto;Kazuhide Koseki;Toshihiko Mayumi;Atsuo Murata;Toshiaki Ikeda;Hiroyasu Ishikura;Masashi Ueyama;Hiroshi Ogura;Shigeki Kushimoto;Daizoh Saitoh;Shigeatsu Endo;Shuji Shimazaki.Critical Care Medicine.2006, 3

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