弥散性血管内凝血
翻译：陈都 校对：肖锋

Title: Disseminated Intravascular Coagulation
弥散性血管内凝血
Author 作者: Michael Winters

Coagulopathies in Critical Illness – DIC
危重症患者凝血病- DIC
Disseminated intravascular coagulation (DIC) is an acquired syndrome of intravascular coagulation and is commonly encountered in critically ill patients.
DIC是一种获得性血管内凝血综合征，在危重症患者中较常见。

Think about DIC in the critically ill patient with oozing at vascular sites (or wounds) and the following lab abnormalities:
如危重症患者有血管或伤口部位渗血及下面异常实验室指标，要考虑DIC：
Thrombocytopenia
血小板减少
Prolonged PT and aPTT
PT和APTT延长
Decreased fibrinogen
纤维蛋白原减少
Elevated fibrin split products and D-dimer
纤维蛋白裂解物和D-二聚体升高

Guidelines for the management of DIC are primarily based on expert opinion and include:
有关DIC处理的指南主要来自于专家意见：

Treat the underlying condition (i.e., sepsis)
处理基础疾病（如脓毒症）
Transfuse platelets if < 50,000 per mm
输血小板（< 50,000/ mm3）
Transfuse FFP to maintain PT and aPTT < 1.5 times normal control
输新鲜冰冻血浆以保持PT和APTT小于1.5倍正常值
Transfuse cryoprecipitate to maintain fibrinogen levels > 1.5 g/L
输冷沉淀以保持纤维蛋白原水平大于1.5 g/L

The use of heparin remains controversial and cannot be routinely recommended.
肝素的使用仍然有争议，不建议常规使用。

References 参考文献
Hunt B. Bleeding and coagulopathies in critical care. NEJM 2014;370:847-59.