内科学教学课件：Disseminated Intravascular Coagulation (DIC)

DisseminatedIntravascularCoagulation(DIC)

Definition

获得性血栓-出血综合征DICisaclinicopathologicalsyndromewhichcomplicatesarangeofillnesses.----获得性，综合征Itischaracterisedbysystemicactivationcoagulationsystem,whichcanresultinthegenerationoffibrinclotsthatmaycauseorganfailurewithconcomitantconsumptionofplateletsandcoagulationfactors,andsecondaryhyperfibrinolysisthesemayresultinclinicalbleeding.----血栓及出血表现并存EventsTriggeringDICInfections•Gram-negativebacteria•Gram-positivebacteria•MalariaTissueInjury•Crushinjury•Burns,Heatstroke•MassiveheadinjuryMalignancy•Acutepromyelocyticleukemia•Acutemonoblasticormyeloblasticleukemia•solidtumorObstetricalcomplications•Maternaltoxemia•Abruptioplacentae•Hemolyticdiseaseofthenewborn•GroupBstreptococcalinfection•RetaineddeadfetusOther•Snakebites•Heparin-inducedthrombosis•shock•Hemolytictransfusionreaction•GraftversushostdiseaseMechanism强调组织因子（TF）在DIC发病中的主导作用

DIC发病中的两个关键物：凝血酶和纤溶酶过量形成。

PathophysiologyofDIChypercoagulationmicrothrombiorganfailureHyperfibrinolysisbleedingDICClinicalFindingsBleedingShockDysfunctionofmultipleorgansMicroangiopathichemolyticanemia：LaboratoryFindingsPT↑aPTT↑Platelets↓Fibrinogen?FDP,D-dimer↑MorphologyofRBCFunctionstatus:Liver,kidney,lung,heart,etcDiagnosisofDICThediagnosisofDICshouldencompassbothclinicalandlaboratoryinformation.DICscoringsystem中国诊断标准国内诊断标准1、存在易于引起DIC基础疾病，如感染、恶性肿瘤、病理产科、大型手术及创伤等2、有下列两项以上临床表现①多发性出血倾向②不易以原发病解释的微循环衰竭或休克③多发性微血管栓塞症状、体征，如皮肤、皮下、粘膜栓塞坏死及早期出现的肾、肺、脑等脏器功能不全④抗凝治疗有效3、实验室检查符合下列标准：同时有以下三项以上异常①血小板低于100×109/L或进行性下降②纤维蛋白原＜1.5g/L或呈进行性下降，或＞4.0g/L③3P试验阳性或FDP＞20mg/L或D二聚体水平升高（阳性）④凝血酶原时间缩短或延长3秒以上或呈动态性变化或APTT延长10秒以上⑤疑难或其他特殊患者，可考虑行抗凝血酶、因子Ⅷ：C及凝血，纤溶、血小板活化分子标记物测定Differentiationdiagnosis严重肝硬化：FⅧ活性检测血栓性血小板减少性紫癜：血小板血栓HELLP综合症：原发性纤溶：D二聚体TreatmentofDICThecornerstoneofthetreatmentofDICistreatmentoftheunderlyingconditi