Chauvet V, Bussac J J, Jullian H, Juhan-Vague I, Branchereau A
Département d'Anesthésie-Réanimation, CHU La Timone, Marseille.
Ann Fr Anesth Reanim. 1991;10(2):164-7. doi: 10.1016/s0750-7658(05)80459-9.
A case of abdominal aortic aneurysm associated with preoperative signs of disseminated intravascular coagulation is reported. The 69-year-old female patient presented with spontaneously appearing petechiae and bruising. She had 0.95 g.l-1 fibrinogen, 105 G.l-1 platelets, and 100 micrograms.ml-1 fibrin and fibrinogen degradation products. Investigations revealed an 80 mm diameter aneurysm of the abdominal aorta, extending from the coeliac trunk to the iliac arteries. Heparin 7,000 IU.day-1 resulted in a biological improvement for a week only. At that time, levels of coagulation factors were: 92% factor II, 88% factor V, 100% factors VII and X, 100% antithrombin III. Surgical cure of the aneurysm was nevertheless carried out. Twenty standard units of platelets, 8 g fibrinogen, four units of fresh frozen plasma, five homologous and two autologous red cell units were transfused during the procedure. No coagulation factors were necessary during the postoperative course, which was uneventful. The management of coagulation factor infusions, before or after aortic cross-clamping, is discussed.
报告了一例腹主动脉瘤合并术前弥散性血管内凝血征象的病例。该69岁女性患者出现自发性瘀点和瘀斑。她的纤维蛋白原水平为0.95 g·l-1，血小板计数为105 G·l-1，纤维蛋白及纤维蛋白原降解产物水平为100微克·ml-1。检查发现腹主动脉有一个直径80毫米的动脉瘤，从腹腔干延伸至髂动脉。每天7000国际单位的肝素仅使病情在一周内有所改善。当时，凝血因子水平为：凝血因子II 92%，凝血因子V 88%，凝血因子VII和X 100%，抗凝血酶III 100%。尽管如此，还是对动脉瘤进行了手术治疗。手术过程中输注了20个标准单位的血小板、8克纤维蛋白原、4单位新鲜冰冻血浆、5单位同型红细胞和2单位自体红细胞。术后过程顺利，无需使用凝血因子。文中讨论了主动脉交叉钳夹前后凝血因子输注的管理。
