论文部分内容阅读
病历摘要 例1.患者男,48岁,因肺癌行右肺切除术后9个月,头痛、伴恶心、呕吐并持续性加重3个月,就诊于我院神经外科。检查:患者情况较好。CT平扫显示额叶占位性病变,确诊为肺癌脑转移。查血小板计数155×10~9/L、pt 12s、APTT 27s、FIB 4.2p/L。经行脑瘤切除治疗并常规给予抗感染药物。术后患者神志清晰,恢复较好。术后第5天发现患者牙龈出血,急查血小板,血小板计数为39×10~9/L,第6天为20×10~9/L,并出现皮肤有出血点,其他情况好,给予浓缩血小板静滴,第7天血小板计数为17×10~9/L,查凝血机制常规,PT 1s、APTT 45s、FIB 1.7g/L、3P试验阳性、乙醇胶试验阳性、D-Diner 1000～2000~g/L,诊断为DIC,并对症治疗,于第8天患者神志不清,家属要求出院。 例2.患者男,48岁,因头痛、呕吐、抽搐就诊于我院神经外科。检查:病人全身情况较好,头颅CT检查发现颅内肿瘤,临床疑为转移癌,经检查确诊为肺癌转移。行右额叶脑转移瘤切除术。术前凝血机制常规检查均在正常范围内,术后第3天患者牙龈出血,立即进行一系列凝血机制检查:
Case Summary 1. Patient male, 48 years old, with 9 months of right lung resection for lung cancer, headache, nausea, vomiting and persistent exacerbation for 3 months. He was treated at our department of neurosurgery. Check: The patient is in better condition. CT plain scan showed frontal occupying lesions and was diagnosed as brain metastases from lung cancer. The platelet counts were 155×10~9/L, pt 12s, APTT 27s, and FIB 4.2p/L. The brain tumors were excised and routinely given anti-infective drugs. The patient was conscious and recovered well after surgery. On the 5th day after operation, the patient’s gum was found to be bleeding. The platelet count was 39.10-9/L. On the 6th day, it was 20.times.10.sup.-9/L. There was a bleeding point on the skin. Other conditions were good. Platelet infusion, platelet count was 17×10-9/L on day 7, check coagulation mechanism routine, PT 1s, APTT 45s, FIB 1.7g/L, 3P test positive, ethanol gel test positive, D-Diner 1000～2000 ~g/L, diagnosed as DIC, symptomatic treatment, on the 8th day the patient was unclear and the family requested discharge. Example 2. Patient male, 48 years old, presented to our department of neurosurgery for headache, vomiting and convulsions. Examination: The whole body of the patient is in good condition. Intracranial tumors were found on the head CT scan. Clinically suspected metastatic cancer was diagnosed as lung cancer metastasis. Right frontal brain metastases were removed. Preoperative coagulation mechanisms were routinely examined within the normal range. On the 3rd day after the operation, the patients had bleeding gums and immediately performed a series of coagulation mechanisms: