106.2 📚 國考版

對象醫垫國考 / PGY / R1。聚焊栞心敞字與 trial 名皱。

106.2.0.1 📌 䞀頁重點 (Quick Recall)

項目 æ•žå­— / Trial
TRICC threshold (穩定) Hb < 7 g/dL
ACS threshold Hb < 8 g/dL (FOCUS)
MTP ratio 1 : 1 : 1 (PROPPR)
TXA timing < 3 hr (CRASH-2 / WOMAN / HALT-IT)
Class III shock HR > 120, BP ↓
Class IV shock HR > 140, lethargic
男 70kg 血容積 ~ 5,000 mL
倱血 1,500 mL ~ 30% (Class III)

106.2.0.2 必背 Trials

Trial 結論
TRICC (1999) Restrictive (Hb 7) ≥ liberal (Hb 10) in stable ICU
TRISS (2014) Septic shock: Hb 7 = Hb 9 (no difference)
FOCUS (2011) Post-hip-fracture + cardiac risk: Hb 8 = Hb 10
PROPPR (2015) Trauma 1:1:1 ≥ 1:1:2 (24-hr mortality)
CRASH-2 (2010) TXA 1g + 1g/8hr in trauma (within 3 hr) → mortality ↓
WOMAN (2017) TXA in PPH → mortality ↓
HALT-IT (2020) TXA in UGIB → no significant benefit (negative trial!)
PROBE restrictive transfusion safe across ICU populations

⚠ HALT-IT 泚意: TXA 未顯著降䜎 UGIB 死亡率 — 與 CRASH-2 / WOMAN 䞍同。䜆仍倚敞䜿甚為暙準。

106.2.0.3 易混淆對照

對照 區別
急性 vs 慢性倱血 急性 normocytic + hypovolemia; 慢性 microcytic IDA
Class II vs III Class II BP 正垞 (代償); Class III BP ↓ (倱代償)
TRICC 對象 穩定 ICU; active bleeding 䞍適甚
PROPPR Trauma; 1:1:1 vs 1:1:2
FFP vs Cryoprecipitate FFP = all clotting factors; Cryo = factor I, VIII, vWF, XIII (specific factor replacement)

106.2.0.4 必背敞字

  • 男性 70 kg: blood volume ~ 5 L (70 mL/kg)
  • 倱血 15% / 30% / 40% = Class I / III / IV 邊界
  • TRICC: Hb 7
  • ACS: Hb 8
  • MTP: 1:1:1
  • TXA: 3 hr 內
  • 1 unit PRBC ≈ Hb ↑ 1 g/dL (in 70 kg adult)
  • 1 unit platelet ≈ platelet ↑ 30-50 K
  • 1 unit FFP ≈ 200-300 mL, 含党郚 clotting factors