产科DIC56例临床分析

Obstetrics disseminated intravascular coagulation:clinical analysis of 56 cases

目的探讨产科DIC的发病特点和诱因,防治和减少DIC的发生。方法对1993～2003年诊治的产科DIC56例进行回顾性分析。结果产科DIC的发生率为024%,9107%的产科DIC发生在产后24h内,56例患者4例死亡,死亡率为714%,围产儿总数50例,死亡8例,14例行全子宫切除术,子宫切除率为25%。引起产科DIC的原因依次是产后出血、妊高征、妊娠合并重症感染、分娩巴氏水肿胎儿、胎盘早剥、重症肝炎等,而引起产后出血的原因主要是胎盘因素。结论胎盘因素引起的产后出血是产科DIC的最常见病因,其次是妊高征。产妇分娩巴氏水肿胎也是好发DIC的一个不容忽视的高危因素。发病的高危人群有多胎、多产、多次人流或引产、前次剖宫产及妊高征、分娩巴氏水肿胎儿的孕产妇。因此,做好孕期保健、降低剖宫产率、降低巴氏水肿胎儿出生率是预防产科DIC的重要措施。抢救治疗原则是早预防、早发现、早诊断、早治疗。

Objective:To determine the clinical characteristics and the cause of disseminated intravascular coagulation(DIC) in obstetrics,prevent and reduce the occurrence of DIC.Methods:56 cases of obstetrics DIC were analyzed retrospectively during 1993 to 2003 .Results:The incidence of obstetrics DIC was 0.24%. 91.07% of obstetrics DIC were occurred in 24 hours of postpartum. Of 56 cases,4 cases died(7.14%),while 8 neonates died(16%)in 50 neonates. Hysterectomy were performed on 14 cases(25%). The cause of obstetrics DIC in order is postpartum hemorrhage, pregnancy induced hypertension( PIH), serious infections, laboring Bart's fetus, placental abruption, serious hepatitis etc. But the main cause of the postpartum hemorrhage is placental disorder.Conclusion:Postpartum hemorrhage being caused by placental disorder is the major cause of DIC, the next is PIH .The mother laboring Bart's fetus is too one of the causative factors.The high-risk crowd of DIC included multiple pregnancy, multiple parity, multiple induced abortions or labors, previous cesarean section, PIH and the mother laboring HbBart' s fetus. So, enhancing the period health care and reducing the incidence of cesarean section and avoiding the birth of the HbBart's fetus are the most important measures for prevention of DIC . Rescue and treatment principle is early to prevent, early to discover, early to diagnosis and treatment.