— 生理適應 · HARD · MCQ —
一位敗血症病人正經歷瀰散性血管內凝固（DIC）。何項實驗室發現支持此診斷？
A client with sepsis is experiencing disseminated intravascular coagulation (DIC). Which laboratory finding supports this diagnosis?
- ANormal D-dimer level正常的 D-dimer 濃度
- BProlonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)✓ 正解凝血酶原時間 (PT) 和活化部分凝血酶時間 (aPTT) 延長
- CDecreased fibrinogen level纖維蛋白原濃度降低
- DElevated platelet count血小板計數升高
— Explanation · 中文詳解 —
DIC 的特徵是全身廣泛性凝血活化，導致血小板和凝血因子消耗，同時產生過多纖維蛋白溶解物。因此，典型實驗室發現為血小板減少、PT 和 aPTT 延長、纖維蛋白原降低、A-dimer 升高。選項 B 包含 PT 和 aPTT 延長，是 DIC 的重要指標。
DIC is characterized by diffuse systemic activation of coagulation, which leads to consumption of platelets and clotting factors along with excessive fibrinolysis. The typical laboratory findings are therefore decreased platelets, prolonged PT and aPTT, decreased fibrinogen, and elevated D-dimer. Option B, which includes prolonged PT and aPTT, is an important indicator of DIC.
✦ 台美臨床差異
美國在敗血症合併 DIC 治療中，常有多專科團隊（如血液科、重症科）共同擬定治療計畫；台灣亦如此，但團隊合作程度與流程可能因醫院而異。