Hardaway R M
Dept. of Surgery, Texas Tech University, School of Medicine, El Paso 79906.
Compr Ther. 1992 Nov;18(11):17-21.
Disseminated intravascular coagulation (DIC) may cause multiple organ failure. Although DIC may cause capillary occlusion in any and all organs, the lungs, liver, kidneys, gut, heart and brain are particularly affected. Focal brain necrosis can also be caused by DIC. Fibrinolytic therapy will often restore significant blood flow to the capillaries of the lungs. This results in significant increase in lung function because the lung is more resistant to actual necrosis and will resume function once circulation is restored. Administration of fibrinolytic therapy will also prevent liver and kidney failure if started within four hours after trauma. This therapy, when given in low doses intravenously over a twenty-four hour period, has little effect on the coagulation mechanism, and abnormal bleeding, therefore, has not been a concern. It is speculated that if plasminogen activators are effective and safe for treating the intravascular clots of DIC, then perhaps they would be effective in treating other types of intravascular coagulation in the brain, such as various types and degrees of stroke.
弥散性血管内凝血(DIC)可能导致多器官功能衰竭。尽管DIC可导致任何及所有器官的毛细血管阻塞,但肺、肝、肾、肠道、心脏和大脑尤其易受影响。DIC还可引起局灶性脑坏死。纤维蛋白溶解疗法通常可使肺部毛细血管恢复显著的血流。这会使肺功能显著增强,因为肺对实际坏死的耐受性更强,一旦循环恢复就能恢复功能。如果在创伤后四小时内开始使用纤维蛋白溶解疗法,还可预防肝肾功能衰竭。这种疗法在24小时内静脉低剂量给药时,对凝血机制影响很小,因此,异常出血并非问题。据推测,如果纤溶酶原激活剂对治疗DIC的血管内血栓有效且安全,那么它们或许也能有效治疗大脑中其他类型的血管内凝血,比如各种类型和程度的中风。