DIC的诊断与治疗.ppt

DIC的诊断与治疗北京协和医院血液科王书杰2003-03-02DIC的定义DisseminatedIntravascularCoagulationDIC是一种发生于多种疾病或特殊病理状态下,人体凝血系统被激活而引起中小血管内弥漫性微血栓形成及继发性纤溶亢进的综合征。由于DIC发展过程中出现不同程度的血小板和凝血因子水平消耗性减少,也称之为“消耗性凝血病”。--- -------- %------------------------- %%,%.OccurrenceinAPL37~65%.------------ %Amnioticfluidembolism,Abruptioplacentae,----------------- %------------ %-Merrittsyndrome,andestruction(.,severepancreatitis),Recreationaldrugs,Transfusionreactions,TransplantrejectionMortalityDIC----~86%,:ondysfuctionThedegreeofhemostaticfailureIncreasingageTheSimplifiedMechanismofDICThrombinExplosionunderPathologicalConditionsIXa(+VIII)Xa(+V)TF+VIIaThrombinFibrinogenFibrinDecreaseofAT-IIIImpairmentofPCSystemInsufficientTFPICytokines(IL-6,etc.)PlasminogenPlasminFibrinFDPsPAPAI-1GenerationofThrombinMediatedbyTFImpairmentofAnticoagulationPathwaySuppressionofFibrinolysisbyPAI-icPathwaysInvolvedinDICAbnormalCoagulationinDICPhysiologicAnticoagulantPathways