35例恶性实体瘤合并弥漫性血管内凝血的临床分析

The clinical effects analysis of radiotherapy in 35 patients with malignant solid tumors concurrent with disseminated intravascular coagulation

目的探讨恶性实体瘤合并弥漫性血管内凝血的临床特点和治疗方法。方法选取2010年1月至2013年4月间收治的35例恶性实体瘤合并弥漫性血管内凝血患者,分析患者临床表现,并对其进行抗凝和抗血小板等对症治疗,观察临床效果。结果 34例(97.1%)患者出现皮肤出血、瘀斑或紫癜,30例(85.7%)患者有血压下降,20例(57.1%)患者出现四肢栓塞。实验室检查显示,33例患者(94.3%)的D-2聚体>100ng/ml,27例(77.1%)患者纤维蛋白原下降,29例(82.9%)患者凝血酶原时间延长,所有患者均出现血小板下降。经对症治疗后,总有效率为40.0%,死亡率为42.9%。结论去除诱因是治疗恶性实体瘤合并弥漫性血管内凝血的关键,早期抗凝治疗有望提高患者的生存率。

Objective To investigate the clinic characteristics and the experiences of diagnosis and treatment of disseminated intravascular coagulation （DIC） with malignant tumor. Methods From January 2010 to April 2013, 35 patients with malignant solid tumors and DIC were enrolled into this study. Patients＇ clinical characteristics were analyzed, symptomatic treatment was given to these patients, clinical effects were observed after treatment. Results Clinical manifestations： 34 patients（97. 1% ） were presented with skin bleeding, petechiae or purpura, 30 patients （85.7%）had blood pressure decreased, 20 patients had （57. 1% ）limb embolism. Laboratory tests： D-2 dimer of 33 patients（gal. 3% ）were more than 100ng/ml, 27 patients（77. 1 ）% presented with decrease fibrinogen, 29 patients （82. 9% ）presented with prolonged prothrombin time, all patients had platelets decreased. Clinical effect： the total effective rate was 40%, the mortality rate was 42. 9%. Conclusion Removing the incentive is the key to the treatment of malignant solid tumors concurrent with DIC, early anticoagulation is expected to improve the survival rate.