Disseminated intravascular coagulation in patients with multiple organ failure of non-septic origin
Disseminated intravascular coagulation in patients with multiple organ failure of non-septic origin
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DOI：
10.1055/s-2007-995822
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发表时间：
1998-01-01
影响因子：
5.7
通讯作者：
Penner, JA
中科院分区：
文献类型：
--
作者：
Penner, JA
弥散性血管内凝血（DIC）和相关的多器官功能衰竭是严重的，往往是各种非败血症条件的终末事件。在大多数情况下，这些条件是组织因子（促凝血酶原激酶）从受损组织释放的结果，产生有利于凝血酶形成的情况。凝血酶在这一过程中的作用是至关重要的，并用于诱导凝血功能障碍，以及导致相关发病率和死亡率的炎症的许多其他方面。这些疾病的诊断模式已得到很好的确立，除了凝血酶-抗凝血酶III复合物、凝血酶原片段1 + 2和D-二聚体水平升高外，血小板和纤维蛋白原以及抗凝血酶III预期降低;所有这些都有助于识别高凝状态。通常需要支持性治疗来提供止血。然而，凝血病的控制同样重要，不仅需要早期干预，而且需要给予足够的抗血栓形成剂以降低凝血酶消耗凝血因子的能力，以及刺激炎症过程。肝素已被有效地用于许多这些情况下，但遭受其潜在的诱发出血。然而，抗凝血酶III浓缩物没有这种风险，并提供了一种独特的替代品，具有有限但有效的获益记录。其在多器官功能衰竭疾病中的疗效的进一步证据正在等待中。
Disseminated intravascular coagulation (DIC) and associated multi-organ failure are serious and often terminal events of a variety of non-septic conditions. For the most part, these conditions are a result of tissue factor (thromboplastin) release from damaged tissues creating situations that favor thrombin formation. Thrombin's role in this process is critical and serves to induce the coagulopathy, as well as many of the other aspects of inflammation that contribute to the associated morbidity and mortality.Clinical disorders giving rise to DIC fall into categories of trauma, obstetrical complications, malignancies and a variety of inflammatory conditions. Diagnostic patterns for these disorders are well established with an expected decrease in platelets and fibrinogen, as well as antithrombin III, in addition to elevated levels of thrombin-antithrombin III complex, prothrombin fragment 1 + 2, and D-dimer; all of which serve to identify the hypercoagulable state.Management of these coagulopathies requires attention to the bleeding diathesis and the ongoing thrombotic complication. Supportive therapy usually is required to provide hemostasis. However, control of the coagulopathy is of equal importance and requires not only early intervention, but also administration of sufficient antithrombotic agents to reduce thrombin's ability to consume coagulation factors, as well as to stimulate inflammatory processes. Heparin has been employed effectively in many of these situations, but suffers from its potential to induce hemorrhage. Antithrombin III concentrate, however, is devoid of this risk and provides a unique alternative that has had a limited, but effective record of benefits. Further proof of its efficacy in multi-organ failure disorders is awaited.