急性主动脉综合征并发弥漫性血管内凝血的临床研究

刘鹏; 苏德淳; 杨光; 黄日红; 刘俊; 高连君

doi:10.13201/j.issn.1001-1439.2017.11.015

急性主动脉综合征并发弥漫性血管内凝血的临床研究

- 1 大连医科大学附属第一医院心脏重症监护病房 (辽宁大连, 116011);
- 2 大连医科大学附属第一医院心血管内科

详细信息

通讯作者: 黄日红, E-mail:dl_hrh@163.com

中图分类号: R544.1

收稿日期: 2017-07-12

Clinical study of acute aortic syndrome with disseminated intravascular coagulation

- 1 Intensive Care Unit,;
- 2 Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 116011, China

More Information

Corresponding author: HUANG Rihong, E-mail: dl_hrh@163.com

Received Date: 12 July 2017

摘要

摘要: 目的:通过回顾性分析急性主动脉综合征 (AAS) 合并弥漫性血管内凝血 (DIC) 患者诊断、治疗及预后。方法:回顾性分析大连医科大学附属第一医院2013-05-2017-05收治的232例AAS住院患者的临床资料。其中全部入选患者根据其是否合并DIC分为AAS合并DIC组 (AAS-DIC组) 和AAS未合并DIC组 (AAS组), 比较两组之间临床特点的差异。结果:对于入组的232例AAS患者中, 合并DIC共有19例 (8.2%), 患者预后不佳。其中10例入院时确诊DIC患者中, 5例行外科手术治疗, 3例死亡;5例保守治疗患者全部死亡。9例外科术后合并DIC患者中, 5例死亡。AAS组及AAS-DIC组DIC筛选指标均存在显著性差异, 对于外科手术术后合并DIC组, 引流量存在及ICU滞留时间存在显著差异, 但体外循环手术时间及停止循环时间方面均无明显差异。结论:AAS易导致DIC的发生, 外科手术治疗对于救治AAS合并DIC患者虽然有效, 但不能显著改善该类患者的预后。
- 急性主动脉综合征 /
- 弥漫性血管内凝血 /
- 心脏外科手术
Abstract: Objective:To retrospectively analyze the diagnosis, treatment and prognosis of patients with acute aortic syndrome (AAS) complicated with disseminated intravascular coagulation (DIC).Method:The clinical data of 232 patients with AAS admitted to the First Affiliated Hospital of Dalian Medical University from May 2013 to May 2017 were analyzed retrospectively.All the patients were divided into AAS-DIC group and AAS group according to whether or not they suffered from DIC.The clinical characteristics of the two groups were compared.Result:The 232 patients with AAS were enrolled in our research.There were 19 patients (8.2%) with DIC, and the prognosis of them was poor.Among them, 10 patients were diagnosed with DIC at the time of admission.In the 10 cases, 3 of 5 patients died underwent surgical treatment, another 5 patients also died after nonoperative treatment.Of the 19 cases with DIC, 9 patients were diagnosed with DIC after surgery, 5 of 9 patients died.Between AAS group and AAS-DIC group, there was significant difference in the ICU retention time and the existing drainage, but not in cardiopulmonary bypass operation time and cycle time.Conclusion:AAS is prone to DIC and the surgical treatment for AAS patients with DIC is effective, but does not significantly improve the prognosis of these patients.
- acute aortic syndrome /
- disseminated intravascular coagulation /
- cardic surgical procedures

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参考文献(18)

[1]	孔令云, 热沙来提·斯拉吉.不典型急性主动脉夹层3例报道及文献回顾[J].临床心血管病杂志, 2017, 33 (1):99-102.
[2]	GERTLER J P, CAMBRIA R P, BREWSTER D C, et al.Coagulation changes during thoracoabdominal aneurysm repair[J].J Vasc Surg, 1996, 24:936-945.
[3]	戴仕林, 吴伟, 王贤灿, 等.78例累及主动脉弓的主动脉疾病患者弓部处理方式及早期随访结果[J].临床心血管病杂志, 2017, 33 (7):678-682.
[4]	KESTIN A S, VALERI C R, KHURI S F, et al.The platelet function defect of cardiopulmonary bypass[J].Blood, 1993, 82:107-117.
[5]	BLOME M, ISGRO F, KIESSLING A H, et al.Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery[J].Thromb Haemost, 2005, 93:1101-1107.
[6]	HIGASHIURA W, KICHIKAWA K, SAKAGUCHI S, et al.Deteriorating consumptive coagulopathy with type III endoleak following endovascular repair for abdominal aortic aneurysm associated with liver cirrhosis[J].J Endovasc Ther, 2007, 14:421-425.
[7]	KEO H H, DIEHM N, BAUMGARTNER I, et al.Disseminated intravascular coagulopathy caused by endoleak type I:successful treatment by endovascular stent-graft extension[J].Eur J Vasc Endovasc Surg, 2006, 12:98-70.
[8]	ADOLPH R, VORP D A, STEED D L, et al.Cellular content and permeability of intraluminal thrombus in abdominal aortic aneurysm[J].J Vasc Surg, 1997, 25:916-926.
[9]	Sniecinski R M, Chandler W L.Activation of the hemostatic system during cardiopulmonary bypass[J].Anesth Analg, 2011, 113:1319-1333.
[10]	KOSTER A, FISCHER T, PRAUS M, et al.Hemostatic activation and inflammatory response during cardiopulmonary bypass:impact of heparin management[J].Anesthesiology, 2002, 97:837-841.
[11]	CROSS K S, BOUCHIER-HAYES D, LEAHY A L, et al.Consumptive coagulopathy following endovascular stent repair of abdominal aortic aneurysm[J].Eur J Vasc Endovasc Surg, 2000, 19:94-95.
[12]	OHARA N, MIYATA T, OSHIRO H, et al.Adverse outcome following transfemoral endovascular stent-graft repair of an abdominal aortic aneurysm in a patient with severe liver dysfunction:report of a case[J].Surg Today, 2000, 30:764-767.
[13]	Ontachi Y, Asakura H, Arahata M, et al.Effect of combined therapy of danaparoid sodium and tranexamic acid on chronic disseminated intravascular coagulation associated with abdominal aortic aneurysm[J].Circ J, 2005, 69:1150-1153.
[14]	MAJUMDAR G.Long-term management of chronic DIC associated with inoperable aortic aneurysm with low molecular weight heparin[J].Hematol J, 2004, 5:447-448.
[15]	GATATE Y, MASAKI N, SATO A, et al.Tranexamic acid controlled chronic disseminated intravascular coagulation associated with aortic dissection and patent false lumen for three years[J].Intern Med, 2017, 56:925-929.
[16]	ONEDA K, AMANO I, TANAKA H, et al.Effective use of camostat mesilate for chronic disseminated intravascular coagulation complicated by thoracoabdominal aortic aneurysm[J].Rinsho Ketsueki, 2001, 42:30-34.
[17]	FUKUDA N, SHIMOHAKAMADA Y, NAKAMORI Y, et al.Thoracic aortic aneurysm with chronic disseminated intravascular coagulation treated successfully with orally administered camostat mesilate, warfarin and aspirin[J].Rinsho Ketsueki, 2014, 43:199-203.
[18]	KAWANO H, HATA T, UDA A, MAEMURA K.Use of rivaroxaban for the effective management of disseminated intravascular coagulation associated with abdominal aortic aneurysm[J].Intern Med, 2015, 54:2625-2628.