最新 弥散性血管内凝血.ppt

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1、弥散性血管内凝血Disseminatedintravascularcoagulation定义2001年国际血栓与止血学会DIC专题委员会新的定义：“DIC是一种由不同原因引起的，以全身性血管内凝血系统激活为特征的获得性综合征。这种改变可来自并引起微血管系统的损害，严重时可导致器官功能衰竭”。Disseminatedintravascularcoagulationisnotadiseaseorasymptombutasyndrome,whichisalwayssecondarytoanunderly

2、ingdisorder.Thesyndromeischaracterizedbyasystemicactivationofthebloodcoagulationsystem,whichresultsinthegenerationanddepositionoffibrin,leadingtomicrovascularthrombiinvariousorgansandcontributingtothedevelopmentofmulti-organfailure.Consumptionandsubse

3、quentexhaustionofcoagulationproteinsandplatelets,becauseoftheongoingactivationofthecoagulationsystem,mayinduceseverebleedingcomplications,althoughmicroclotformationmayoccurintheabsenceofsevereclottingfactordepletionandbleeding(Levietal,1999).很多疾病都可引起D

4、IC，感染性疾病占36.94%，病理产科24.81%，恶性肿瘤24.2%，手术与创伤4.34%。TableClinicalconditionsthatmaybeassociatedwithdisseminatedintravascularcoagulationSepsis/severeinfection(anymicroorganism)Trauma(e.g.polytrauma,neurotrauma,fatembolism)Organdestruction(e.g.severepancreat

5、itis)MalignancySolidtumoursMyeloproliferative/lymphoproliferativemalignanciesObstetricalcalamitiesAmnioticfluidembolismAbruptioplacentaeTableClinicalconditionsthatmaybeassociatedwithdisseminatedintravascularcoagulationVascularabnormalitiesKasabach-Mer

6、rittsyndromeLargevascularaneurysmsSeverehepaticfailureSeveretoxicorimmunologicalreactionsSnakebitesRecreationaldrugsTransfusionreactionsTransplantrejectionPathogenesisInrecentyears,themechanismsinvolvedinpathologicalmicrovascularfibrindepositioninDICh

7、avebecomeincreasinglyclear.Initiationofcoagulationistissuefactor-dependent;amplificationofthrombingenerationiscausedbydefectivephysiologicalanticoagulantmechanisms;andpropagationoffibrindepositioninthemicrovasculatureiscausedbyinsufficeientfibrindegra

8、dation,asaresultofaninhibitedfibrnolyticsystem(Fig).PathogenesisTraditionally,DICwasthoughttobetheresultofboththeextrinsicandtheintrinsic(contactsystem-mediated)coagulationpathwaysbeingactivated.Inthelast20yearsithasbecomeapparentthatthrombing