初诊急性早幼粒细胞白血病并发弥漫性血管内凝血的治疗

Treatment of the Flrst-diagnosed Acute Premylocytic Leukemia Complicated with Disseminated Intravascular Coagulation

应用反式维甲酸（Ｒｅｔｉｎｏｔｉｃａｃｉｄ，ＲＡ）治疗急性早幼粒细胞白血病，患者生存期明显延长。但并发弥漫性血管内凝血（ＤＩＣ）者，病死率仍很高。Ｍ３ａ、Ｍ３ｂ及早幼粒细胞数高、低均可并发ＤＩＣ。诊断确立之后，应立即口服ＲＡ，同时使用肝素治疗ＤＩＣ，根据凝血时间（ＣＴ）调整肝素用量及间歇时间，使ＣＴ维持在２０～３０ｍｉｎ，肝素用至出血症状停止和ＤＩＣ指标恢复正常，再减量维持１～２周，必需输血时，同时加用肝素，以防止促进ＤＩＣ的发展。

etinotic acid(RA)treatment greatly prolonged APL patients'life expectancy,but the death ratewas very high for those complicated with DIC. DlC might occur in both M3a and M3b with a high orlow level of premylocytes. As soon as the diagnosis was established RA should be taken immediatelyand heparin should be used simultaneously.The dosage of heparin and the interval should be adjustedaccording to clotting time which should be maintained between 20 to 30 minutes. The dosage of heparinshould be reduced and maintained for 1 to 2 weeks after the cessation of bleeding and recovery of DIC in-dexes. Heparin was needed when blood transfusion was necessary in order to avoid the progress of DIC.