[不同病理学的弥散性血管内凝血的致病特点]。

E V Guzovskaya, S N Serebrennikova
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引用次数: 0

摘要

DIC是一种严重的并发症,常导致多器官衰竭和致命的结局。与任何综合征一样,它是多病理性的,其病因众多,逻辑上导致其形成机制多种多样。弥散性血管内凝血综合征的主要表现为血栓和出血。内脏微循环床大量淤积的结果是内脏发生营养不良变化和器官衰竭。出血反过来导致循环血容量减少,动脉低血压和血性缺氧,在大多数严重的情况下导致致命的结果。然而,上述障碍的发展机制和表现程度并不总是相同的。由于该综合征可能由多种原因引起(目前已描述的可发展为该综合征的疾病超过150种),即其初始阶段在最大程度上是不同的。DIC的主要触发机制可能为:血成素激活及其微囊化过程的增加、内源和外源途径的凝血止血激活、抗凝剂的缺乏和纤溶系统的过度活跃。各种病理性因素(脓毒症、产科病理、白血病及其他恶性肿瘤、外伤等)对止血系统各组分的功能有不同的影响。根据上述疾病机制表现的程度,DIC可伴凝血、纤溶或其平衡激活。这些DIC的临床表现以及各阶段的持续时间和表现程度(高凝、代偿性纤溶激活的消耗性凝血病、血液去纤化和纤溶过度激活)也会有所不同。因此,了解在DIC发展方面具有潜在危险的疾病期间止血系统的主要障碍,有助于找到其预防、诊断和治疗的最佳方法。
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[Pathogenic peculiarities of disseminated intravascular coagulation of various ethiology].

DIC is a severe complication, often resulting in multi-organ failure and fatal outcome. As any syndrome, it is polyethiologic, while a big number of its causes logically leads to various mechanisms of its forming. Main manifestations of the disseminated intravascular blood coagulation syndrome are clottage and haemorrhage. A result of a massive clottage in microcirculatory bed of internal organs is development of dystrophic changes in them and organ failure. Haemorrhage in its turn, results in decreased volume of circulating blood, arterial hypotension and hemic hypoxia, in most severe cases leading to the fatal outcome. Although, development mechanisms and manifestation degree of the disorder mentioned above are not always the same. As the syndrome may result from a great number of causes (currently, over 150 diseases have been described with which it can develop), namely its initial stages are different to the greatest extent. Main triggering mechanisms of the DIC may be: blood formed element activation and increased process of their microvesiculation, activation of coagulative hemostasis in intrinsic and extrinsic pathways, lack of anticoagulants and excessive activity of fibrinolytic system. Various ethiologic factors (sepsis, obstetrical pathology, leucosis and other malignant tumours, traumas, etc) have different effect on function of hemostasis system components. Depending on the degree of the above mentioned disorders mechanisms manifestation, the DIC may develop with prevailing coagulation, with prevailing fibrinolysis or with their balanced activation. Clinical manifestations of these DIC forms, as well as duration and manifestation degree of its stages (hypercoagulation, coagulopathy of consumption with compensatory activation of fibrinolysis, defibrination of the blood and excessive activation of fibrinolysis) will be different as well. Consequently, knowing the prevailing disorder in hemostasis system during a disease that is potentially dangerous in terms of the DIC development offers to find optimal methods of its prevention, diagnosing and treatment.

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