Kirsch W, Büttner M, Wenzel E
Monatsschr Kinderheilkd (1902). 1977 Jun;125(6):621-7.
The diagnosis of defibrination syndrome in shock, sepsis and neonatal hypoxia is based, in addition to the clinical picture, upon a few parameters of the hemostatic system, which, in part as global tests, provide information about the course of coagulation. The parameters measured are partial thromboplastin time, thromboplastin time, plasma thrombin time, fibrinogen, thrombin-coagulase and reptilase times as well as platelet count. Normal values of these laboratory parameters were established for healthy newborns 1--5 days of age, and for healthy adults. It is suggested that especially partial thromboplastin time, the thrombin-coagulase and reptilase times, the latter influenced by fibrinolysis cleavage products, are representative for the tentative diagnosis of disseminated intravascular coagulation with fibrinolysis syndrome (DICFS). The platelet fall often lags 1--2 days behind the event. Moreover normal values for newborns, are markedly higher than those for older children or adults. In the presence of DICFS, a low-dose heparin therapy is immediately initiated. If completed defibrination is manifest, therapy is supplemented with urokinase and streptokinase, For DICFS with congenital sepsis, an exchange transfusion with heparinized fresh blood is the treatment of choice.
除临床表现外，休克、脓毒症及新生儿缺氧时去纤维蛋白综合征的诊断还基于止血系统的一些参数，这些参数部分作为整体检测，可提供凝血过程的信息。所检测的参数包括部分凝血活酶时间、凝血酶原时间、血浆凝血酶时间、纤维蛋白原、凝血酶 - 凝固酶和蛇毒凝血酶时间以及血小板计数。已确定了1 - 5日龄健康新生儿和健康成年人这些实验室参数的正常值。有人提出，尤其是部分凝血活酶时间、凝血酶 - 凝固酶和蛇毒凝血酶时间（后者受纤维蛋白溶解裂解产物影响）对伴有纤维蛋白溶解综合征的弥散性血管内凝血（DICFS）的初步诊断具有代表性。血小板下降通常比事件晚1 - 2天。此外，新生儿的正常值明显高于大龄儿童或成年人。在存在DICFS时，立即开始低剂量肝素治疗。如果出现完全去纤维蛋白现象，则用尿激酶和链激酶补充治疗。对于先天性脓毒症所致的DICFS，首选治疗是用肝素化新鲜血液进行换血疗法。
