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目的探讨恶性实体瘤合并弥漫性血管内凝血的临床特点和治疗方法。方法选取2010年1月至2013年4月间收治的35例恶性实体瘤合并弥漫性血管内凝血患者,分析患者临床表现,并对其进行抗凝和抗血小板等对症治疗,观察临床效果。结果 34例(97.1%)患者出现皮肤出血、瘀斑或紫癜,30例(85.7%)患者有血压下降,20例(57.1%)患者出现四肢栓塞。实验室检查显示,33例患者(94.3%)的D-2聚体>100ng/ml,27例(77.1%)患者纤维蛋白原下降,29例(82.9%)患者凝血酶原时间延长,所有患者均出现血小板下降。经对症治疗后,总有效率为40.0%,死亡率为42.9%。结论去除诱因是治疗恶性实体瘤合并弥漫性血管内凝血的关键,早期抗凝治疗有望提高患者的生存率。
Objective To investigate the clinical features and treatment of malignant solid tumor with disseminated intravascular coagulation. Methods From January 2010 to April 2013, 35 patients with malignant solid tumor complicated with diffuse intravascular coagulation were selected and their clinical manifestations were analyzed. The patients were treated with anticoagulant therapy and antiplatelet therapy, and the clinical effect was observed. Results Thirty-four (97.1%) patients developed skin hemorrhage, ecchymosis or purpura, and blood pressure was decreased in 30 (85.7%) patients and extremity embolism in 20 patients (57.1%). Laboratory tests showed fibrinogen decreased in D-2 aggregates> 100 ng / ml in 33 patients (94.3%), fibrinogen in 27 patients (77.1%) in 29 patients (82.9%), prolonged prothrombin time in all patients Thrombocytopenia occurred. After symptomatic treatment, the total effective rate was 40.0%, the mortality rate was 42.9%. Conclusion The removal of inducement is the key to the treatment of malignant solid tumor with disseminated intravascular coagulation. Early anticoagulant therapy is expected to improve the survival rate of patients.