危重病人术中术后DIC的预防及应对方案

Prophylaxes and treatment of intraoperative and postoperative DIC in critical patients

弥漫性血管内凝血(DIC)可使许多疾病演进过程复杂化,危重病人发生手术创伤时尤甚。此时血栓形成与出血常同时存在,使临床医师面临两难境地,病死率极高。因此对于外科危重病人,预防重于治疗。预防的重点在于减少危重病人DIC发生的高危因素,如:当术中术后需要输血时,要采取"鸡尾酒式的输血方式",即输血成分需合理搭配;并给予适当抗炎治疗。此外还应积极纠正低体温、酸中毒、大出血、感染、血液瘀滞等情况。一旦发生DIC,在积极治疗原发病的基础上,适当输注血液制品,酌情使用肝素;并发脓毒血症时,还可使用抗凝血酶或活化蛋白C等;慎用抗纤溶药。

Many diseases would become complicated by reason of DIC, especially in critical patients that suffered from operation trauma. Since thrombosis may coexist with hemorrhage in those patients, clinical doctors usually feel awkward. So the mortality is very high. Thus, the prevention of DIC is more important than the treatment to surgical patients. The prevention should be emphasized on decreasing the risk factors of DIC, such as： appropriate collocation of blood product transfusion, anti-inflammatory therapy, and correction of hypothermia, acidosis, massive hemorrhage, infection, blood stasis and so on. When DIC occurs, blood product and heparin could be used in condition, in the basis of treatment of primary diseases. AT and APC could be administered when DIC complicates with sepsis. Anti-fibrinolysis should be used carefully in DIC.