产科弥散性血管内凝血诊断与治疗专家共识解读

Interpretation of expert consensus on diagnosis and treatment of disseminated intravascular coagulation in obstetrics

弥散性血管内凝血(disseminated intravascular coagulation,DIC)是一种严重的临床综合征,由于多种疾病导致微血管体系损伤,诱导凝血酶过度活化,广泛形成微血管血栓、大量凝血因子消耗,继而发生纤溶亢进。在妊娠期,胎盘早剥、子痫前期/HELLP综合征、羊水栓塞、严重感染等均为诱发DIC的严重产科并发症。其临床起病急、变化快,易发展为严重休克和多器官功能衰竭,严重威胁母婴的健康和生命。为了提高我国临床工作者对该疾病的认识,降低孕产妇和胎婴儿的死亡率,改善妊娠结局,中华医学会血液学分会起草了《产科弥散性血管内凝血临床诊断与治疗中国专家共识》。文章就该共识中有关产科DIC的发病机制、临床表现、实验室检查、诊断标准和治疗等方面进行了详细解读。

Disseminated intravascular coagulation(DIC)is an acquired syndrome characterized by the intravascular activation of coagulation with a loss of localization arising from different causes.It can originate from and cause damage to the microvasculature,which if sufficiently severe,can produce organ dysfunction.On the basis of physiologic hypercoagulability in pregnant women,it is easy to induce DIC if placental abruption,preeclampsia,HELLP syndrome,amniotic fluid embolism,infection and other serious conditions are complicated.The clinical manifestations show the characteristics of rapid onset and rapid change,and are prone to severe shock and multiple organ failure,which seriously affect the survival and health of mothers and infants.To improve the awareness of Chinese clinical workers about this disease,reduce maternal and fetal mortality,and improve pregnancy outcomes,the Hematology branch of the Chinese Medical Association formulated the"Chinese Expert Consensus on Clinical Diagnosis and Treatment of Obstetric Disseminated Intravascular Coagulation".This article interprets the pathogenesis,clinical manifestations,laboratory tests,diagnostic criteria and treatment of obstetric DIC in the consensus.