弥散性血管内凝血 .pptx

弥散性血管内凝血;;;;;;;;;血管内皮细胞在抗凝血中的作用Vascular Endothelial Cells Anticoagulation;;问题: DIC的概念? 主要的体液抗凝因素?;;产科并发症: 胎盘释放组织因子 急性早幼粒白血病:胞浆颗粒释放组织因子 癌细胞:一些癌细胞胞膜表达组织因子 感染性疾病:内毒素外毒素激活单核细胞 IL-1,TNF 内皮细胞组织因子表达↑ 组织损伤:脑、肺、胎盘等组织因子最丰富 ; 严重感染和内毒素血症 强烈免疫反应生成过量抗原-抗体复合物 持续广泛的组织缺血缺氧 严重酸中毒等;;问题: DIC的形成机制?;高凝期: 凝血酶增多,微血栓形成。 消耗性低凝期: 凝血因子、血小板消耗,纤溶系统激活,出血。 继发性纤溶期: 纤溶酶增多,FDP形成。;依照DIC发生快慢: 1、 急性型 2、 慢性型 3、 亚急型 依照代偿情况: 1、 失代偿型2、 代偿型3、 过度代偿型;各型DIC的特征 Characteristics of Different DIC Types;失代偿型:凝血因子和血小板消耗占优势,数量减少;临床表现:出血、休克;多见于急性型DIC。 代偿型:凝血因子和血小板的生成和消耗基本平衡,临床表现不明显或轻微;多见于轻度DIC。 过度代偿型:凝血因子和血小板生成超过消耗;临床表现不明显;多见于慢性或恢复期DIC。;问题: DIC的分期与特点? DIC的分型?;DIC的功能代谢变化 Functional Metabolic Changes of DIC;凝血因子、血小板过度消耗 纤溶系统激活(子宫,前列腺,肺富含纤溶酶原激活物;应急,缺氧→内皮细胞释放纤溶酶原激活物↑) 纤维蛋白降解产物(FDP)形成,对凝血酶,血小板聚集及纤维蛋白交联抑制;;;;问题: 华-佛综合征、席汉综合征? 微血管病性溶血性贫血?; 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、 ; 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)、 ; 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 ret