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目的 总结产科急性弥漫性血管内凝血(DIC)患者子宫切除围术期的处理经验。方法 8 例产科DIC患者,年龄22~37岁,出血量4 000~12 000 ml,平均出血量7 700 ml,MAP (32±19)mmHg,皮肤、创面、注射针眼广泛渗血4例,紫绀、呼吸困难1例,昏迷1 例。立即开放2~3 条静脉通道,选择气管内插管全麻。氯胺酮诱导,异丙酚、芬太尼维持麻醉;机械正压通气;监测BP、SpO2 及CVP,术中监查血气、血小板计数及凝血象等。积极抗休克、及时足量补充凝血因子及改善出凝血状态,抗纤溶、纠正酸中毒;适时脱水、利尿。结果 8例患者均于入室后8~10 min内开始手术,2.5 h内结束手术。术中输入浓缩红细胞(30±15)IU,新鲜冰冻血浆(3 500±1 000)ml,冷沉淀(25±15)IU,6例输入血小板(3±1)IU。手术结束时循环稳定,创口无明显渗血,DIC实验室全套检查均明显改善。1 例因糖尿病、肾衰抢救无效死亡。7 例治愈出院。结论 全麻、呼吸支持、抗休克、及时足量补充凝血因子、纠酸、脱水、利尿等围术期处理对成功救治产科DIC患者具有重要意义。
Objective To summarize the experience of perioperative hysterectomy in patients with obstetric acute diffuse intravascular coagulation (DIC). Methods Eight patients with obstetric DIC, aged 22-37 years, with blood loss ranging from 4 000 to 12 000 ml, with an average bleeding volume of 7 700 ml and MAP (32 ± 19) mmHg, were extensively bleeding in skin, wounds and needle-injection eyes. 1 case of dyspnea, 1 case of coma. Immediately open 2 to 3 intravenous access, endotracheal intubation general anesthesia. Ketamine-induced, propofol, fentanyl to maintain anesthesia; mechanical positive pressure ventilation; monitoring of BP, SpO2 and CVP, intraoperative monitoring of blood gas, platelet count and coagulation. Positive anti-shock, adequate and timely replenishment of coagulation factors and improve the coagulation state, anti-fibrinolytic, correct acidosis; timely dehydration, diuretic. Results All 8 patients underwent surgery within 8-10 min after entering the room, and the operation was completed within 2.5 h. Intraoperative input of packed red blood cells (30 ± 15) IU, fresh frozen plasma (3 500 ± 1 000) ml, cryoprecipitate (25 ± 15) IU, 6 cases of platelet transfusion (3 ± 1) IU. Circulatory stability at the end of surgery, no significant bleeding wounds, DIC laboratory tests were significantly improved. 1 case of death due to diabetes, failure of renal failure. Seven patients were cured. Conclusions General anesthesia, respiratory support, anti-shock, adequate and timely replacement of clotting factor, correction of acid, dehydration, diuretic and other perioperative treatment of successful treatment of obstetric patients with DIC is of great significance.