凝血平衡课件.ppt

Laboratory tests showed a rapidly falling hemoglobin level and a platelet count of 25,000/μL (normal150，000/μL). The prothrombin time (PT) was 29 sec (normal, 12.5). The level of fibrinogen degradation products was 360-520 g/L (normal, 40) and the plasma antithrombin III level was 28% (normal, 80-120). Clinical Case Based on these findings, the diagnosis was DIC secondary to severe trauma. Surgical exploration revealed diffuse oozing of blood at the site of the operation, but only partial surgical hemostasis could be achieved. The patient was given supportive treatment with large infusions of fresh plasma and platelet concentrates. The bleeding stopped 48 hours later. Coagulation parameters eventually returned to normal and the subsequent clinical course was uneventful. Clinical Case DIC治疗的病理生理基础 Pathophysiological Basis of DIC Treatment 1. 积极防治原发病 2. 早期发现、及时治疗 抗凝治疗 保护重要脏器功能 补充凝血物质 适当的抗纤溶治疗 Vocabulary disseminated intravascular coagulation (DIC;弥散性血管内凝血) prothrombin (凝血酶原), thrombin (凝血酶) fibrinogen (纤维蛋白原)，fibrin (纤维蛋白)， tissue factor pathway inhibitor (组织因子途径抑制物) protein C system (蛋白C系统) thrombinmodulin (血栓调节蛋白) antithrombin Ⅲ (抗凝血酶Ⅲ) Vocabulary tissue plasminogen activator (t-PA；组织纤溶酶原激活物) plasminogen (纤溶酶原)，plasmin (纤溶酶), fibrinolysis (纤维蛋白溶解) fibrin degradation products(FDP, 纤维蛋白降解产物) Waterhouse syndrome (华-佛综合征) Sheehan syndrome (席-汉综合征) microangiopathic hemolytic anemia (微血管病性溶血性贫血) schistocyte (裂体细胞) Thanks! 谢谢！ 高分子激肽原, 前激肽释放酶 are synthesized in the liver VIIIa increase the speed of the reaction from X to Xa 200,000-fold faster. IV: Ca2+ Source: Liver: fibrinogen (I), prothrombin (II), V,VII,IX,X,XI,XII,XIII Platelets: III, V,VIII,, XIII Endothelial cells: VIII, XIII Thrombin activates factor V VIII The injured tissues and endothelium very slowly release tissue plasminogen activator (t-PA；组织纤溶酶原激活物) a day or later after clot is formed and convert plasminogen to plasmin. Plasmin具有广泛的丝氨酸水解酶活性，能水解凝血终产物fibrin生成可溶性的纤维蛋白降解产物（fibrin