DIC弥漫性血管内凝血-北京协和医院血液科.pptxVIP免费

DIC的诊断与治疗北京协和医院血液科第一页，共三十九页。DIC的定义•DisseminatedIntravascularCoagulation•DIC是一种发生于多种疾病或特殊病理状态下，人体凝血系统被激活而引起中小血管内弥漫性微血栓形成及继发性纤溶亢进的综合征。•由于DIC开展过程中出现不同程度的血小板和凝血因子水平消耗性减少，也称之为“消耗性凝血病〞或“消耗性血栓出血性疾病〞。第二页，共三十九页。ClinicalconditionsassociatedwithDIC1.Sepsis/Severeinfection-----------44.6%2.Malignancy-------------------------20.7%–Solidtumors6.9%，AL13.8%.OccurrenceinAPL37~65%.3.Obstetricalcalamities------------13.4%–Amnioticfluidembolism,Abruptioplacentae,Deadfetus4.Trauma/Surgery-----------------7.4%5.Severehepaticfailure------------7.4%6.Vascularabnormalities–Kasabach-Merrittsyndrome，Largevascularaneurysms7.Organdestruction(e.g.,severepancreatitis)8.Severetoxicorimmunologicreactions–Snakebites，Recreationaldrugs，Transfusionreactions，Transplantrejection第三页，共三十九页。Mortality•DIC----DeathIsComing.•Mortalityrangesfrom31~86%,whetherornotheparinwasadministrated.•CorrelatedFactors:–Underlyingdisorders–Theextentoforgondysfuction–Thedegreeofhemostaticfailure–Increasingage第四页，共三十九页。ContactFactorPathwayTissueFactorPathway(IntrinsicPathway)(ExtrinsicPathway)KallikreinPrekallikrein“TissueDamage”XIIXIIaTissueFactorHKC-1InhibitorXIXIaIXCa++Ca++VIIIVIIIaIIaIIIIaVaVProteinCAPCProteinSPCInhibitorTMSKIIaIIaFibrinogenFibrinMonomerAT-IIIHCF-IIFibrinPolymerFibrinClotFDPXIIIaCa++Plasmin2AntiplasminPlasminogenUKt-PAPAI-1FibrinolysisSystemCoagulationandFibrinolysis(VIIa)XaIXaCa++PLXaXVIIaVIITFPICa++PLXIIIIIaCa++Ca++PLCa++PL第五页，共三十九页。TheSimplifiedMechanismofDIC第六页，共三十九页。DIC的失调控•Sepsis、Cancer、Trauma、Obstetricalcomplications:TF•LiverDisease:AT-III、PC/PS•Sepsis:TM、PC•Pregnancy:PS•APL、AmnioticFluidEmbolism、ProstateCancer:Plasmin第七页，共三十九页。ThrombinExplosionunderPathologicalConditions第八页，共三十九页。IXa(+VIII)Xa(+V)TF+VIIaThrombinFibrinogenFibrinDecreaseofAT...