杨素平

[摘要] 目前由产后出血引起的失血性休克在我国孕产妇死亡原因中居首位，若短时间内不能迅速止血纠正休克，会迅速发展为弥漫性血管内凝血（DIC）。DIC是在原发病基础上，促凝因素导致机体微血管内广泛地生成微血栓，消耗了大量凝血因子和血小板，并伴以继发性纤溶为特征的获得性血栓——出血综合征。DIC本身并不是一个独立的疾病，而是很多疾病发病的一个中间环节和病理过程。它的主要临床症状可归纳为出血、微循环障碍、多器官功能障碍和贫血。产后一旦发生DIC，将严重威胁产妇的生命安全。但是如果能及早发现，及时治疗，尚能挽救患者的生命。因此，当发生产后大出血时要时刻警惕DIC的发生，做到早发现，早诊断，早治疗，为抢救患者生命提供有利时机。在2013年12月21日，本院成功抢救了1例因宫缩乏力致产后失血性休克进而发生弥漫性血管内凝血的产妇，并报道如下。

[关键词] 产后出血；失血性休克；DIC；护理

[中图分类号] R473.71   [文献标识码] B   [文章编号] 2095-0616（2014）08-141-03

The rescue and nursing experience about one case of postpartum hemorrhagic shock complicated with DIC

YANG Suping

Yizheng Maternity Hospital of Nanjing Gulou Hospital Group,Yizheng 211900,China

[Abstract] At present,the hemorrhagic shock caused by postpartum hemorrhage ranks first in the cause of maternal deaths in our country.If can not stop bleeding quickly correct shock in a short period,then will rapidly develop to disseminated intravascular coagulation(DIC). DIC is a secondary,with extensive micro thrombosis and coagulation dysfunction appeared pathological characteristics of the clinical syndrome. It is a pathological condition of many obstetric diseases in the process of development,which resulted in extensive hemorrhage,hemolytic,multiple organ dysfunction,tissue ischemia,necrosis,shock,and it is a serious threat to the safety of pregnant women.Characteristics of obstetric DIC is urgent,heavy,dangerous and high rates of maternal mortality,such as early detection,timely treatment,can save the lives of patients. Therefore,the nurse is very important in the treatment of DIC rescue cooperation. In December 21,2013,the hospital maternal 1 case of uterine atony postpartum hemorrhagic shock complicated with DIC,report as follows now.

[Key words] Postpartum hemorrhage;Hemorrhagic shock;Disseminated intravascular coagulation;Nursing

产后出血是指胎儿娩出后24h内失血量超过500mL，剖宫产时超过1000mL，是分娩期的严重并发症，子宫收缩乏力、胎盘因素、软产道裂伤及凝血功能障碍是产后出血的主要原因。而失血过多引起的继发性凝血功能障碍表现为持续性阴道流血，血液不凝；全身多部位出血、身体淤斑。根据临床表现及血小板计数、纤维蛋白原、凝血酶原时间等凝血功能检测可作出诊断。

1 病例报道

患者，女，29岁，G3P1，孕39周，于2013年12月20日21：40经……