重症烧伤患者早期凝血功能变化探究  

Exploration of the changes of early coagulation function in patients with severe burns

作　　者：赵婧楠 蒋航 陈宾 汤文彬 邓忠远 张涛[1] 张旭辉 钟晓旻 李孝建 Zhao Jingnan;Jiang Hang;Chen Bin;Tang Wenbin;Deng Zhongyuan;Zhang Tao;Zhang Xuhui;Zhong Xiaomin;Li Xiaojian(Department of Burns and Plastic Surgery,Guangzhou Red Cross Hospital of Jinan University,Guangzhou 510220,China)

机构地区：[1]暨南大学附属广州市红十字会医院烧伤整形科,广州510220

出　　处：《中华烧伤与创面修复杂志》2023年第11期1057-1063,共7页Chinese Journal of Burns And Wounds

基　　金：广州市医学重点学科。

摘　　要：目的探究重症烧伤患者早期(即伤后14 d内)凝血功能变化。方法采用回顾性病例系列研究方法。2018年12月—2019年12月, 暨南大学附属广州市红十字会医院收治50例符合入选标准的重症烧伤患者, 根据烧伤严重程度, 将患者分为重度烧伤组(17例, 其中男12例、女5例)和特重度烧伤组(33例, 其中男26例、女7例)。收集患者入院时、伤后48 h与72 h和伤后7 d与14 d患者的血小板计数(PLT)、常规凝血功能指标和血栓弹力图指标水平。常规凝血指标包括凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)以及纤维蛋白原(FIB)和D-二聚体水平, 血栓弹力图指标包括凝固角(即α角)、凝血综合指数(CI)以及MA值、R值和K值(分别反映最大振幅、凝血反应时间、血液凝固时间)。对数据行独立样本t检验、Wilcoxon秩和检验和χ^(2)检验。对2组患者各指标数据进行混合效应模型验证, 同时对PLT行重复测量方差分析。对所有患者的血栓弹力图指标数据(除CI外)分别与PLT和常规凝血指标数据之间的相关性进行Pearson相关分析或Spearman相关分析。结果入院时、伤后48 h与72 h和伤后7 d与14 d, 重度烧伤组患者的PLT分别为(203±91)、(148±70)、(123±63)、(203±62)、(402±140)×10^(9)/L, 特重度烧伤组患者的PLT分别为(235±116)、(145±71)、(109±52)、(235±106)、(455±138)×10^(9)/L, 总体比较, 仅时间因素主效应差异有统计学意义(F=92.55, P<0.05), 重度烧伤组患者PLT仅伤后7 d与其相邻的2个时间点(伤后72 h及伤后14 d)的比较, 差异有统计学意义(P值均<0.05);特重度烧伤组患者PLT各相邻时间点之间的比较, 差异均有统计学意义(P<0.05)。2组患者各时间点的PT、TT、FIB水平总体比较, 仅时间因素主效应差异有统计学意义(F值分别为6.04、8.45、32.90, P值均<0.05), 特重度烧伤组患者伤后14 d内的APTT、FIB水平均长于/高于重度烧伤组。2组�Objective To study the changes of early(i.e.,within post injury day(PID)14)coagulation function in patients with severe burns.Methods A retrospective case series study was conducted.From December 2018 to December 2019,50 severe burn patients who met the inclusion criteria were admitted to Guangzhou Red Cross Hospital of Jinan University.According to the severity of burns,the patients were divided into severe burn group(17 cases,including 12 males and 5 females)and extremely severe burn group(33 cases,including 26 males and 7 females).The platelet count(PLT),and conventional coagulation indexe and thromboelastogram index levels of patients were collected at admission,post injury hour(PIH)48 and 72,and on PID 7 and 14.The conventional coagulation indexes included prothrombin time(PT),thrombin time(TT),activated partial prothrombin time(APTT),and fibrinogen(FIB)and D-dimer levels.The thromboelastogram indexes included coagulation angle(i.e.,αangle),coagulation composite index(CI),MA value,R value,and K value(reflecting maximum amplitude,coagulation reaction time,and blood agglutination time,respectively).Data were statistically analyzed with independent sample t-test,Wilcoxon rank sum test,and chi-square test.Verification of the mixed effect model was performed on each index data of patients in the two groups,while the repeated measures analysis of variance was performed on PLT.Pearson correlation analysis or Spearman correlation analysis were performed to analyze the correlation between the thromboelastogram index data(except CI)and the PLT and conventional coagulation index data,respectively.Results At admission,PIH 48 and 72,and on PID 7 and 14,PLT of patients in severe burn group were(203±91),(148±70),(123±63),(203±62),(402±140)×10^(9)/L,respectively,PLT of patients in extremely severe burn group were(235±116),(145±71),(109±52),(235±106),(455±138)×10^(9)/L,respectively.In overall comparison,only the difference of the main effect of time factor was statistically significant(F=92.55,P<0.05).In severe

关 键 词：烧伤 血小板 血栓弹力描记术 凝血 伤后早期 危重症 

分 类 号：R644[医药卫生—外科学]