重度烧伤患者烧伤初期内环境改变及输血治疗的探讨
중도소상환자소상초기내배경개변급수혈치료적탐토
Investigation of internal environment changes and transfusion therapy at early burn stage of severe burn patients
  • 万方数据
    国际输血及血液学杂志 국제수혈급혈액학잡지
    INTERNATIONAL JOURNAL OF BLOOD TRANSFUSION AND HEMATOLOGY
    2015年 1期 18-23 ,共6页

    陈妙婵%蔡葵

    진묘선%채규

    烧伤%输血%凝血功能%血常规检查 燒傷%輸血%凝血功能%血常規檢查
    소상%수혈%응혈공능%혈상규검사
    Burns%Blood transfusions%Coagulation function%Hematologic tests
    目的 探讨重度烧伤患者烧伤初期内环境改变及输血治疗的临床意义.方法 选择2010年1月至2014年5月于广东省佛山市第一人民医院收治的大面积重度烧伤初期患者43例为研究对象,纳入研究组.于治疗期间不同时间点检测其血常规、凝血功能、动脉血气分析及血液生化指标等体内内环境变化情况.对其除给予常规烧伤治疗外,同时根据烧伤面积、烧伤程度、手术出血、创面渗血及病情发展情况,给予适当的成分输血治疗,观察患者输血情况并监测其内环境变化.选择同期于同一医院体检的健康受试者43例纳入对照组.对两组的血常规、凝血功能、动脉血气分析及血液生化指标等体内内环境指标进行统计学分析.本研究遵循的程序符合广东省佛山市第一人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象的知情同意,并与之签署临床研究知情同意书.两组受试者年龄、性别构成比等基线资料比较,差异均无统计学意义(P＞0.05).结果 ①研究组患者在烧伤初期均存在不同程度的凝血功能障碍.其中,烧伤后第1天内其凝血酶原时间(PT)、国际标准化比值(INR)及活化部分凝血酶时间(APTT)均显著高于对照组,且差异均有统计学意义(P＜0.05);凝血酶时间(TT)除入院时显著高于对照组外,在其他时间点均显著低于对照组(P＜0.05),且差异均有统计学意义(P＜0.05);纤维蛋白原(FIB)含量从烧伤后第3天起均显著高于对照组,且差异均有统计学意义(P＜0.05).②研究组患者烧伤初期亦存在不同程度的酸中毒.其中,烧伤后第1天其血液pH值、全血剩余碱(BE)含量及HCO3-浓度均显著低于对照组,且差异均有统计学意义(P＜0.05).③与对照组比较,研究组患者烧伤后第1天的红细胞计数、血红蛋白(Hb)水平、血细胞比容(Hct)均较对照组显著增高,差异均有统计学意义(P＜0.05),反映重度烧伤患者的血液呈浓缩状态,而烧伤后第3天这些指标均明显下降,与烧伤第一天比较,差异均有统计学意义(P＜0.05);烧伤后第1天,其血小板计数显著升高,与对照组比较,差异有统计学意义(P＜0.05),随后开始下降,但烧伤后第21天再次升高,与对照组比较,差异有统计学意义(P＜0.05);烧伤后48 h内,对研究患者输注的成分血以血浆为主,随着治疗时间延长,输血量明显增多,红细胞、血小板和冷沉淀多种成分血均须输注,并且烧伤后第3～14天内,患者红细胞计数、Hb水平及Hct多项指标经输血治疗后均较输血前显著提高,差异均有统计学意义(P＜0.05).结论 动态监测重度烧伤患者烧伤初期内环境变化情况,及时调整治疗方案,同时给予科学合理的输血治疗是成功救治重度烧伤患者的关键.
    목적 탐토중도소상환자소상초기내배경개변급수혈치료적림상의의.방법 선택2010년1월지2014년5월우광동성불산시제일인민의원수치적대면적중도소상초기환자43례위연구대상,납입연구조.우치료기간불동시간점검측기혈상규、응혈공능、동맥혈기분석급혈액생화지표등체내내배경변화정황.대기제급여상규소상치료외,동시근거소상면적、소상정도、수술출혈、창면삼혈급병정발전정황,급여괄당적성분수혈치료,관찰환자수혈정황병감측기내배경변화.선택동기우동일의원체검적건강수시자43례납입대조조.대량조적혈상규、응혈공능、동맥혈기분석급혈액생화지표등체내내배경지표진행통계학분석.본연구준순적정서부합광동성불산시제일인민의원인체시험위원회제정적윤리학표준,득도해위원회비준,정득수시대상적지정동의,병여지첨서림상연구지정동의서.량조수시자년령、성별구성비등기선자료비교,차이균무통계학의의(P＞0.05).결과 ①연구조환자재소상초기균존재불동정도적응혈공능장애.기중,소상후제1천내기응혈매원시간(PT)、국제표준화비치(INR)급활화부분응혈매시간(APTT)균현저고우대조조,차차이균유통계학의의(P＜0.05);응혈매시간(TT)제입원시현저고우대조조외,재기타시간점균현저저우대조조(P＜0.05),차차이균유통계학의의(P＜0.05);섬유단백원(FIB)함량종소상후제3천기균현저고우대조조,차차이균유통계학의의(P＜0.05).②연구조환자소상초기역존재불동정도적산중독.기중,소상후제1천기혈액pH치、전혈잉여감(BE)함량급HCO3-농도균현저저우대조조,차차이균유통계학의의(P＜0.05).③여대조조비교,연구조환자소상후제1천적홍세포계수、혈홍단백(Hb)수평、혈세포비용(Hct)균교대조조현저증고,차이균유통계학의의(P＜0.05),반영중도소상환자적혈액정농축상태,이소상후제3천저사지표균명현하강,여소상제일천비교,차이균유통계학의의(P＜0.05);소상후제1천,기혈소판계수현저승고,여대조조비교,차이유통계학의의(P＜0.05),수후개시하강,단소상후제21천재차승고,여대조조비교,차이유통계학의의(P＜0.05);소상후48 h내,대연구환자수주적성분혈이혈장위주,수착치료시간연장,수혈량명현증다,홍세포、혈소판화랭침정다충성분혈균수수주,병차소상후제3～14천내,환자홍세포계수、Hb수평급Hct다항지표경수혈치료후균교수혈전현저제고,차이균유통계학의의(P＜0.05).결론 동태감측중도소상환자소상초기내배경변화정황,급시조정치료방안,동시급여과학합리적수혈치료시성공구치중도소상환자적관건.
    Objective To explore the clinical significance of internal environment changes and transfusion therapy at early burn stage of severe burn patients.Methods From January 2010 to May 2014,forty-three early extensive severe burn patients who hospitalized in Foshan First People's Hospital of Guangdong Province were enrolled into this study,as study group.Detect the internal environment changes at different time during treatment,such as routine blood test,blood coagulation function,blood gas analysis,blood biochemical indicators and so on.Except of conventional burn treatment,appropriate component transfusion therapy was conducted on patients at the same time,according to its burn surface area and burn degree,volume of surgical hemorrhage,blood oozing from the wound surface and the progression of disease.Analyze the blood transfusion and internal environment changes of early severe burn patients.Forty-three cases of healthy who took health examination in the same hospital during the same period were chose as control group.Statistical analysis was performed on two groups of routine blood test,blood coagulation function,arterial blood gas analysis,blood biochemical indicator and so on.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Foshan First People's Hospital of Guangdong Province.Informed consent was obtained from all participants.There were no significant differences about age and gender between two groups (P＞0.05).Results ① At the early stage of burn,sever burn patients had different degree of coagulation dysfunction.Within one day after burning,the prothrombin time (PT),international normalized ratio (INR) and activated partial thromboplastin time (APTT) of study group were higher than t.hose of control group,and the differences were statistically significant (P＜0.05) ; At the time of admission,thrombin time (TT) of study group was higher than that of control group,and the difference was statistically significant (P＜0.05),and at other time during hospitalization it was lower than that of control group,and the difference was statistically significant (P＜0.05).Three days after burning,the content of fibrinogen (FIB) of study group was higher than that of control group,and the difference was statistically significant (P＜0.05).② At the early stage,early sever burn patients also had different degree of acidosis.Within one day after burning,the pH value,concentration of whole blood base excess (BE) and HCO3 of study group were all lower than those of control group,and the differences were statistically significant (P＜0.05).③ One day after burning,red blood cell count,level of hemoglobin (Hb),hematocrit (Hct) of study group increased significantly compared with those of control group,and the differences were statistically significant (P＜ 0.05),reflecting the condensed state of blood.And there days after burning,these three indicators decreased compared with those of control group.Within 24 hours after burning,platelet count of study group increased,and the difference was statistically significant (P＜ 0.05),then decreased,and increased again three weeks after burning,and the difference was statistically significant (P＜0.05) ; Within 48 hours after burning,patients with severe burns in study group were transfused plasma in major.And the volume of blood transfusion increased significantly as treatment prolonged,so a variety of blood components were transfused to them,such as red blood cells,platelets and cryoprecipitate.Three days to fourteen days after buring,red blood cell count,level of Hb and Hct of study group improved significantly after transfusion,and the differences were statistically significant (P ＜ 0.05).Conclusions Monitoring the internal environment changes of severe burn patients dynamically at the early stage of burn and adjusting the treatment plan timely,while giving reasonable transfusion therapy at the same time is the key to successful treatment of severe burn patients.
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