每日一题_2022.1.6

A 70-year-old man was involved in a head-on motor vehicle collision in which he was the restrained driver traveling 40 miles per hour. He is brought by emergency medical services to the emergency department, where he is combative, with a Glasgow Coma Scale (GCS) score of 8, and intubated for airway protection and further imaging. Vital signs are stable. CTs of the head, cervical spine, chest, abdomen, and pelvis reveal a right subdural hematoma without midline shift and a grade II spleen laceration（裂伤）. His family cannot remember any of his medications. Trauma laboratory results are pending. Thromboelastography (TEG) is shown below. 

Based on the TEG results and the patient’s injuries, which of the following products is most appropriate?

A. Platelets

B. Tranexamic acid(氨甲环酸)

C. Fresh frozen plasma or prothrombin complex concentrate（凝血酶原复合物） 

D. Cryoprecipitate（冷沉淀）

投票结果：

答案解析：

血栓弹力图(TEG)在创伤患者的处理中越来越常见。与凝血因子的静态实验室测量值（凝血酶原时间、部分凝血活酶时间、INR、血小板计数）相比，TEG提供了更快速和动态的全血凝血评估。这允许对止血功能进行整体评估，并有助于及时干预。尽管没有正式的试验证明TEG在创伤患者中的统计学益处，但许多创伤中心仍然采用了它的使用。
许多遭受创伤的患者因各种原因服用某种类型的血液稀释药物。医疗服务提供者通常不知道这些信息。在该患者中，硬膜下血肿和格拉斯哥昏迷量表评分为8分，有必要快速逆转抗凝剂以达到最佳可能结局。与参考相比，R时间延长，这意味着他缺乏凝血因子。新鲜冷冻血浆或凝血酶原复合物浓缩液可能有助于逆转这种情况，请记住，一些新型抗凝剂可能对这些治疗仍无反应。α角和最大振幅在正常范围内，因此不需要冷沉淀或血小板。最后，没有需要使用氨甲环酸的纤维蛋白溶解证据。

Reference:
1. Thakur M, Ahmed AB. A review of thromboelastography. Int J Periop Ultrasound ApplTechnol. 2012;1(1):25-29.

正确答案：

C

补充内容：