disseminated intravascular coagulationDIC

DICDIC disseminated intravascular coagulationDIC

DIC ---- ----

DIC

2DIC

--1IL-1TTNFTNF-ELAM-1

3

PAFPAF3

1

Adhesion GpIIb/IIIaPlateletGpIbCOLLAGENTHROMBIN 2

2

APF5HT-TGPF4VWFPGI2TXA2PF3 3

1

XIIXIIKXIIaXIXIaXIIaXIaTFVIIVIIa2

3DIC

1C

DICFXaFVIIIaFVIIaFVaATAPCPSTFPIDIC 2

1FXIIaHMWK scu-PAtcu-PAPAI-2sct-PAtct-PAPAI-1 2- 2- XIIIaFPA/B X,Y,D,E,B15-42, A,B,C,HX,YD,E,D-X,Y,D,E,B1-42A,B,C,HC1-

DICADP 1

RBC

RBC ADP RBC 2

-DIC1

CCC IL-1TNFCTF

2

-+ClqrsCIsC2C4C2aC2bC4b +C4aC4b2aCVFBC3bCVF-BC3b-BCVF-BbC3b-BbC3C3bC3aC5b-C9

DD

1

C3bPK C5b C5a DIC 2

DIC4

(I,II,V,VII,VIII AB IX,X,XI,XII) () FDP ,

DIC

DICDICDIC

DIC125%~40%A

DIC 1015 15DICDIC1

DIC

5070DIC DIC1

DIC

DIC

DIC

DIC1

DIC 1

DICDIC 2

DIC 1. 2.DIC 3.DIC

DIC -- -- -- --- --

()DIC 3

DIC1

DIC2

%%%Pltn=823s912757APTT(n=82)>10s914257TTn=82>3s836070Fgn=710.25mg/L916880n=80>2%237351

3

PT+APTT+TTn=82831151PT+APTT+Fgn=712210065PT+APTT+FDPn=71917186FDP+DDn=39919495PT+APTTn=82913456

sFMC/TPP1

TFTFPI2TFDICDIC

TFPIT-TFPIF-TFPILP-TFPI T-TFPI > LP-TFPI >F-TFPI

-TAT3DIC88%63%79%88%pre-DIC

-PAP4PAPpre-DICpre-DIC

5

DIC1

DIC31plt3s,APTT >10s

5AT:A

DIC19804ESR18sFg

DIC51plt60mg/LD-D6TATFPAsFMCF1+2

:SFMC-TAT-PAPTAFITpP Pre-DIC1

t-PA/PAIAPC/PCID-DDSTM

Pre-DIC1

Pre-DIC

DIC a b c d Pre-DIC2

aPT3APTT 5 b-TGPF4TXB2P- cF1+2TATFPASFMC dAT-IIIAPC eET-1TM

Pre-DIC2

DIC5Pre-DIC 5 Pre-DIC

(TF)(SFM)A(FPA)(>2pmol/ml)-(TAT)(>4ug/ml)B15-42(>1pmol/ml)-(PAP)(>1)D-(>3)III(

DICDIC DICDICnon-overt DICDIC DICDICovert DIC

DIC4

DIC DICDICDIC DICDIC DIC4

DIC

DIC DIC* *

DIC DICDIC

10000LMWHATLMWHLMWHXa4:1LMWH2AAT-ATXaLMWH-PAPGILMWH24 LMWH1

2

LMWH3

4

5PTFg>1.5g/L,pltAPTTATA>80%APTT>2.5

Sakugawa124DIC61LMWHFR-8606375Xa/kg5FR-860 33.3% 18.5%20%8.2%32.5%25.7%93.4%79.7%4.9%10.9%0%,7.8% LMWHDIC6

Oguma1990LMWH FragminDIC56DICFragmin27Xa/kg29150u/kg566.7%54.7%3.7%10.3%31.6%14%66.7%51.7%75Xa/kgLMWHFragminDIC

LMWHDIC6

1DIC DIC0.005mg/Kg.h4~6d

2 Lys

ATAntithrombinAT70%-80% ATDIC: DICATAT ATDIC1

ATATDICAT120%AT=120%-ATXkg1.0% Iu/kg, AT80%AT1AT

fresh frozen plasma ,FFPACDCPD6-30FFP1~5VIIIVIIIvWF 2

CAPC3 FaFaFa DIC6mg/d 3~4d

CUPCI4DICpre-DIC0.5~1.0mg/Kg

PAI-15 Moutes33B8PAI-1DIC

6PCCVIIIAHG

29 810.64/6.65kPa(80/50mmHg)95/

Hb70g/L110~150RBC2.71012/L3.5~5.0 12/L85 109/L100~300 109/L1.78g/L2~4g/L20.912~143P+++RBC++4h75 109/L1.6g/L

DIC

Multiple pathways are responsible for platelet activation.Platelets adhere to damaged blood vessels via cell surface adhesion molecules and their membrane receptors such as glycoprotein Ib/IX (GP Ib/IX), the ligand for von Willebrand factor (VWF), which in turn can activated platelets and cause conformational changes.

Further, other activators including thrombin, adrenaline, ADP, and collagen can also activate platelets. When activation occurs, the glycoprotein IIb/IIIa membrane receptor (GP IIb/IIIa) is exposed. This receptor forms bridges using fibrinogen resulting in aggregation.

Platelet activation also exposes a phospholipid surface (meeting place) upon which coagulation proteins carry out their reactions. The sequential activation of these coagulation factors ultimately leads to the formation of fibrin, which is a critical component in stabilizing the hemostatic plug.

Thrombin when generated, plays a pivotal role in hemostasis, via both fibrin conversion and platelet activation.