Milutinovich J, Follette W C, Scribner B H
Ann Intern Med. 1977 Feb;86(2):189-92. doi: 10.7326/0003-4819-86-2-189.
Six patients developed spontaneous retroperitoneal bleeding while on maintenance dialysis (3% of all patients so treated). At the time of the bleeding episode, four patients were receiving Coumadin for prevention of recurrent clotting problems in external shunts. In three patients, including two who had not received Coumadin, bleeding developed while on dialysis. The presenting common symptoms and signs of retroperitoneal bleeding included sudden and progressive abdominal pain with blood pressure drop and subsequent development of an abdominal mass. These symptoms were associated with a falling hematocrit without any documented external blood loss and with suggestive X-ray changes, including absence of psoas shadow with soft tissue density. All six patients recovered. Treatment included blood transfusions, temporary regional heparinization, withdrawal of Coumadin, and bed rest. Surgical exploration was undertaken in two patients, but no obvious bleeding source was found. Anticoagulation therapy and functional platelet abnormalities may be contributory causes.
6例维持性透析患者发生自发性腹膜后出血（占所有接受该治疗患者的3%）。出血发作时，4例患者正在服用香豆素以预防体外分流反复出现凝血问题。3例患者，包括2例未服用香豆素的患者，在透析期间发生出血。腹膜后出血的常见症状和体征包括突发且进行性加重的腹痛、血压下降以及随后出现腹部肿块。这些症状与血细胞比容下降相关，且无任何记录在案的外部失血，同时伴有提示性的X线改变，包括腰大肌阴影消失及软组织密度影。所有6例患者均康复。治疗措施包括输血、临时局部肝素化、停用香豆素以及卧床休息。2例患者接受了手术探查，但未发现明显出血源。抗凝治疗和功能性血小板异常可能是促成因素。
