继发性凝血机制障碍创伤后迟发性出血分析

The cause of secondary disturbance of blood coagulation of delayed hemorrhage after trauma

目的分析继发性凝血机制障碍的原因,探讨术中出血不止的急救措施。方法2例继发性凝血机制障碍致迟发性出血,出现骨筋膜室综合征。1例髂腰肌内血肿在超声引导下穿刺血肿减压。另1例右股骨周围巨大血肿,切开血肿减压术中出血不止,以纱布填塞压迫止血,36h后取出纱布闭合伤口。结果髂腰肌血肿1例观察16周血肿吸收机化血肿无复发。右股骨周围血肿1例术中纱布填塞止血,应用600U凝血酶原复合物出血停止。术后36h闭合伤口。伤口闭合术后3d患肢感觉恢复正常,足背动脉搏动良好。伤口闭合术后10d再次出血不止,右股骨骨及肌肉组织病理学检查为股骨远端骨肉瘤。结论口服抗凝血药物华法令,大量出血可造成获得性凝血因子缺乏。骨的恶性肿瘤可造成局部弥漫性出血不止。继发性凝血机制障碍术中出血不止危及患者生命时,果断终止手术,以纱布填塞压迫止血是术者唯一正确的选择。

Objective To analyze the cause of secondary disturbances of blood coagulation and to investigate the first-aid measure to treat non-stopping bleeding in operation. Methods Two cases of osteofascial compartment syndrome with tardive hematoma caused by secondary disturbance of blood coagulation were enrolled in the study. One cases of iliopsoas muscle hematoma was depressed by ultrasonic guiding puncturation. Another enormous hematoma around right femoral bone suffered from non-stopping bleeding after decompression procedure of hematoma discission by way of carbasus obturation. After 36 hours, and the wound was closed after taking out the carbasus. Results No recurrence happened to the case with iliopsoas muscle hematoma after 16 weeks as a result of absorption and degeneration, As the patient with right femoral bone hematoma referred , the bleeding stopped after treated by carbasus obturation and application of 6 00 U prothrombin complex. The wound was closed 36 hours after the operation. A satisfactory sensory recovery and pulsation of dorsal pedal artery and arteria tibialis posterior were got. The non-stopping rebleeding after 10 days was found. The bone and muscular tissue around right femoral bone was examined pathobiologically, The result of the pathobiology inspection was osteoma sareomatosum of distal femur. Conclusion Oral anticoagulant warfarin （WARF） and massive bleeding can lead to disturbance of blood coagulation. The malignant tumor of bone can lead to non-stopping diffuse hemorrhage in partis. This kind of disturbance of blood coagulation can cause continuous bleeding and become a severe threat to patient＇ s life. It is the best choice for the doctor to stop operation immediately and stop bleeding by effective carbasus obturation,