严重创伤并发弥散性血管内凝血36例

Clinical Analysis of 36 Cases of Severe Trauma Complicated with Disseminated Intravascular Coagulation

为探讨创伤并发弥散性血管内凝血 (DIC)的临床和实验室特点及治疗要点 ,提高创伤并发DIC的诊治水平 ,对 1 980年至 1 998年收治的 36例严重创伤并发DIC病例进行了回顾性分析。共有 2 8例合并感染 ,2 5例出现休克 ,急性呼吸窘迫综合征 (ARDS) 1 0例。临床上以全身多部位反复出血、难治性休克、多脏器功能不全为主要表现。均有血小板进行性下降、凝血酶原时间 (PT)延长、3P阳性等实验室变化。 2 5例给予小剂量肝素治疗 ,死亡 9例 ,病死率 36 %。提示严重创伤病人合并感染和休克时应警惕DIC的发生。血小板进行性下降、PT延长、3P阳性是创伤DIC诊断的重要指标。创伤DIC时ARDS发生率较高 ,应引起重视。应用小剂量肝素抗凝可提高创伤DIC的治愈率。

To investigate the clinical and experimental features of trauma complicated with disseminated intravascular coagulation (DIC) and to improve the level of diagnosis and treatment to trauma complicated with DIC, 36 cases of trauma complicated with DIC from 1980 to 1998 were analysed. All the cases were severely injuried , among which 4 cases were in early stage of DIC and 32 cases were in late stage; 28 cases complicated with infections, 25 with shock and 10 with ARDS. The primary clinical features were repetitive and multiple hemorrhage in the whole body, refractory shock or multiple organ malfunction. All the cases showed the progressive reduction of Plt, prolongation of PT and 3P positive. Twenty- five cases were treated with low-dose heparin, 9 of the 25 cases died, the morality was 36%. The most important predisposing factors leading to DIC in severe trauma are infection and shock. The continuous reduction of Plt, prolongation of PT and positive of 3P are important to the diagnosis of DIC. ARDS incidence is high in traumatic DIC. The use of low-dose heparin may improve the treatment result.