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1969年1月至1974年5月共观察86例急性肾功能衰竭,其中27例伴有弥漫性血管内凝血(DIC)。86例中有产科病例21例,外科20例,外伤5例,内科37例,病因不明2例。另1例系心导管检查后患者。DIC的诊断标准为:①血小板计数≤15万/立方毫米。②凝血酶原时间≥15秒。③纤维蛋白原≤1.6克/升。所有病例均排除了肝脏疾患,每例均予通常的急性肾功能衰竭治疗措施。在27例中有弥漫性血管内凝血的患者中,有12例静脉给予肝素钠。第一天内平均剂量为300毫克,每4小时一次。肝素的剂量以将凝血酶时间或凝血时间控制在比对照延长1倍为准。伴有DIC患者的死亡率为59.2％,无DIC者为44.4％,但并无统计学的意义。15例未经肝素治疗的DIC患者死亡率60％,应用肝素治疗的12例DIC患者则为58％。除小出血外,12例接受肝素的患者中有10例发生严重并发症。其中9例因胃肠道出血而停药。1例在治疗3天后发生腹膜后血肿而需作外科引流。未用肝素治疗的病例胃肠道出血的发生率较少,15例中仅有5例。27例急性肾功能衰竭伴有DIC者的死亡原因:8例死于胃肠道出血(其中2例伴脓毒
A total of 86 patients with acute renal failure were observed from January 1969 to May 1974, 27 of them with diffuse intravascular coagulation (DIC). There were 21 cases of obstetric cases, 20 cases of surgical trauma, 5 cases of trauma, 37 cases of internal medicine and 2 cases of unknown etiology. Another case of cardiac catheterization after the patient. DIC diagnostic criteria: ① platelet count ≤ 150,000 / cubic millimeter. ② prothrombin time ≥ 15 seconds. ③ fibrinogen ≤ 1.6 g / l. All cases were ruled out of liver disease, each case are given the usual treatment of acute renal failure. Among 27 patients with disseminated intravascular coagulation, 12 received intravenous heparin sodium. The first day the average dose of 300 mg, once every 4 hours. Heparin dose to control the thrombin time or clotting time than the control to double. Mortality was 59.2% in patients with DIC and 44.4% in those without DIC, but not statistically significant. The mortality rate was 60% in 15 non-heparin-treated patients with DIC and 58% in 12 patients treated with heparin. In addition to minor bleeding, 10 of the 12 patients who received heparin developed serious complications. Nine of them discontinued due to gastrointestinal bleeding. One patient had retroperitoneal hematoma after 3 days of treatment and needed surgical drainage. The incidence of gastrointestinal bleeding was lower in non-heparin treated patients, with only 5 of 15 patients. Causes of death in 27 patients with acute renal failure and DIC: 8 died of gastrointestinal bleeding (2 of them with sepsis