每日一题_2022.09.25

A 65-year-old woman with a history of hypertension and peptic ulcer disease presents with three episodes of melena at home, occasional hematochezia, lightheadedness, and fatigue. Vital signs are: temperature 37.2°C (99°F), heart rate 130 beats/min, blood pressure 100/60 mm Hg, and oxygen saturation 93% on 2-L nasal cannula. After large-bore access is obtained, she is given 2 liters of crystalloid. Hemoglobin is 5.6 g/dL (one week ago it was 11.2 g/dL). She undergoes emergent endoscopy, which shows an actively bleeding ulcer with erosion of the gastroduodenal artery. The ulcer is cauterized and hemostasis is achieved. She is transferred to the ICU for closer hemodynamic monitoring. During the first six hours after admission, she received about 5 units of packed red blood cells (PRBCs) for resuscitation. Hemoglobin has remained stable at 7.5 g/dL after the endoscopic procedure.

Which of the following statements regarding coagulopathy related to repeated PRBC transfusions in hemorrhagic shock best reflects consensus guidelines?

A. One unit of fresh frozen plasma (FFP) should be transfused for every unit of PRBCs.

B. One unit of FFP should be transfused for every two units of PRBCs.

C. There are no consensus guidelines regarding the optimal ratio of FFP to PRBCs for transfusion.

D. Cryoprecipitate should be administered to any patient who receives more than 2

答案解析：

失血性休克患者输注浓缩红细胞 (PRBC) 后获得性凝血功能障碍的概念存在争议。根据对军事和平民伤亡的回顾性研究，许多临床医生采用新鲜冷冻血浆 (FFP) 与 PRBC 的输注比例为 1:1 或 1:2。大量输血策略与更少的器官功能障碍、更多的无呼吸机天数和更少的腹腔室综合征有关。使用FFP并非没有风险；输血相关的急性肺损伤、急性呼吸窘迫综合征 (ARDS) 和多器官功能障碍的风险增加。目前没有关于使反复输红细胞后用 FFP 的共识。北美实用、随机最佳血小板和血浆比率 (PROPPR) 试验是一项 III 期随机对照试验，目前正在研究不同血液制品的输血比例对接受大量红细胞输血的患者的影响。他们的主要终点是 24 小时和 30 天死亡率。

正确答案：C