Levi M
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Crit Care. 2001 Dec;16(4):167-77. doi: 10.1053/jcrc.2001.30666.
The incidence of sepsis and complications stemming from septicemia has remained constant in recent years despite improved levels of monitoring and care. Disseminated intravascular coagulation (DIC), a syndrome that occurs frequently in septic patients, is associated with increased mortality. Organ dysfunction is also a common sequela that is strongly correlated with DIC. Cytokines released early in the course of sepsis stimulate a procoagulant state that causes development of intravascular fibrin deposition. In a later stage of DIC, bleeding may occur in parallel because of consumption of clotting factors and inhibitors. Therapeutic strategies to attenuate or reverse these conditions have focused on multiple stages of the molecular cascade of events, including preventing cytokine induction, inhibiting coagulation processes, and promoting fibrinolysis. Recent clinical trials have supported the use of antithrombin and activated protein C supplementation in DIC associated with severe sepsis. Studies of other novel therapeutic avenues are still ongoing. Future efforts may be directed at combining 2 or more agents to achieve prompt and successful reversal of DIC.
尽管监测和护理水平有所提高，但近年来败血症及败血症引发的并发症的发病率一直保持稳定。弥散性血管内凝血（DIC）是败血症患者中经常出现的一种综合征，与死亡率增加有关。器官功能障碍也是一种常见的后遗症，与DIC密切相关。败血症病程早期释放的细胞因子会刺激促凝状态，导致血管内纤维蛋白沉积。在DIC的后期，由于凝血因子和抑制剂的消耗，可能会同时出现出血症状。减轻或逆转这些病症的治疗策略集中在分子事件级联反应的多个阶段，包括预防细胞因子诱导、抑制凝血过程和促进纤维蛋白溶解。最近的临床试验支持在与严重败血症相关的DIC中使用抗凝血酶和补充活化蛋白C。对其他新型治疗途径的研究仍在进行中。未来的努力可能会致力于联合使用两种或更多药物，以迅速且成功地逆转DIC。
