静吸复合麻醉对特重度烧伤患者凝血功能障碍的影响

doi:10.3877/cma.j.issn.2095-9133.2022.01.003

目的

收集特重度烧伤(总TBSA50%以上或三度TBSA20%以上或伴有严重并发症者)患者围术期凝血指标(APTT、PT、FIB、DD和PLT)，分析静吸复合麻醉对患者凝血功能的影响及其临床意义。

方法

选取近3年内蒙古医科大学第三附属医院烧伤外科收治的特重度烧伤患者148例，根据入院14 d内的预后分为死亡组和生存组，生存组男性129例，女性9例；年龄24~59岁，平均(43.30±12.90)岁。死亡组男性8例，女性2例；年龄26~63岁，平均(46.19±15.41)岁。收集入院时(T0)，术前(早晨入手术室前，T1)，术毕(送至PACU未拔除气管导管前，T2)及术后2 d(T3)4个时间点的凝血指标，比较两组凝血指标动态差异。

结果

死亡组休克期输液量、累计血浆、红细胞输入量显著高于生存组(P<0.01)。T0时，生存组的FIB(1.78±0.32)显著高于死亡组(1.26±0.07)(P<0.05)；T2时，两组APTT、PT均显著缩短(P<0.05)，生存组的FIB(3.86±0.40)显著高于死亡组(2.45±1.02)(P<0.05)；T3时，死亡组PLT显著低于生存组(P<0.01)。

结论

特重度烧伤患者在围手术期易出现高凝状态，并且这可能导致患者死亡。静吸复合麻醉和围术期大量液体复苏会促进患者的高凝状态。

关键词: 烧伤, 凝血功能障碍, 血小板, 纤维蛋白原

Objective

Collecting perioperative coagulation indexes (APTT, PT, FIB, DD and PLT) from patients with extra-severe burns and analyzing the effect of sedation compound anesthesia on patients’ coagulation function and its clinical significance.

Methods

In the past three years, 148 patients with severe burns admitted to the Burn Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University were selected. They were divided into the survival group [129 males, 9 females; age 24-59 years, mean (43.30±12.90) years] and the death group [8 male cases, 2 female cases; age 26-63 years, mean (46.19±15.41) years]. The coagulation markers were recorded within 7 days after injury. The dynamic differences of coagulation markers were compared between the survival group and the death group.

Results

The amount of fluid infusion, cumulative plasma and red blood cell input in the shock period of the death group was significantly higher than that of the survival group (P<0.01), the difference was statistically significant. At T0, the FIB of the surviving group (1.78±0.32) was significantly higher than that of the dead group (1.26±0.07) (P<0.05); at T2, APTT and PT were significantly shorter in both groups (P<0.05), and the FIB of the surviving group (3.86±0.40) was significantly higher than that of the dead group (2.45±1.02) (P<0.05); at T3, the death group PLT was significantly lower than that of the surviving group (P<0.01).

Conclusion

Patients with extra-severe burns are prone to a hypercoagulable state in the perioperative period, which can lead to death. Intravenous compound anesthesia and perioperative resuscitation with large amounts of fluids can promote a hypercoagulable state in patients.

Key words: Burns, Coagulation dysfunction, Platelet, Fibrinogen

表1 两组患者一般临床资料的比较(±s)

组别	例数	年龄(岁)	性别(女/男)	TBSA(%)	APACHEⅡ(分)	休克期输液量(mL)	累计晶体输入量(mL)	累计血浆输入量(mL)	累计红细胞输入量(U)
存活组	138	43.30±12.90	9/129	68.43±11.76	37.24±4.39	12 758.56±3 784.29	22 519.63±5 681.62	9 619.28±1 637.27	9.13±4.69
死亡组	10	46.19±15.41	2/8	87.90±7.86	51.67±3.09	16 498.38±5 138.58	27 953.84±2 177.48	11 799.12±4 737.31	14.25±5.93
t/F值		1.29	2.89	1.66	1.66	2.35	1.65	2.35	2.36
P值		>0.05	>0.05	<0.05	<0.05	<0.01	<0.05	<0.01	<0.01

表1 两组患者一般临床资料的比较(±s)

组别	例数	年龄(岁)	性别(女/男)	TBSA(%)	APACHEⅡ(分)	休克期输液量(mL)	累计晶体输入量(mL)	累计血浆输入量(mL)	累计红细胞输入量(U)
存活组	138	43.30±12.90	9/129	68.43±11.76	37.24±4.39	12 758.56±3 784.29	22 519.63±5 681.62	9 619.28±1 637.27	9.13±4.69
死亡组	10	46.19±15.41	2/8	87.90±7.86	51.67±3.09	16 498.38±5 138.58	27 953.84±2 177.48	11 799.12±4 737.31	14.25±5.93
t/F值		1.29	2.89	1.66	1.66	2.35	1.65	2.35	2.36
P值		>0.05	>0.05	<0.05	<0.05	<0.01	<0.05	<0.01	<0.01

图1 两组患者FIB、PLT的动态变化趋势注：FIB为纤维蛋白原，PLT为血小板；两组间FIB和PLT的差异有统计学意义：^aP<0.05

表2 两组患者凝血指标、PLT动态变化(±s)

组别		APTT(s)	PT(s)	FIB(g/L)	DD(mg/L)	PLT(×10⁹/L)
存活组
	T0	42.09±9.03	18.48±1.55	1.78±0.32	1.36±0.96	372.3±122.5
	T1	40.59±7.87	17.24±2.69	3.56±0.58	3.05±1.45	214.6±65.2
	T2	36.58±6.45	15.09±1.32	3.86±0.40	5.37±1.04	149.4±21.7
	T3	35.76±3.38	13.92±3.92	5.10±0.90	6.90±1.21	135.6±36.1
死亡组
	T0	65.83±10.03	24.48±1.68	1.26±0.07^a	2.06±0.49	398.7±118.2
	T1	62.95±7.57	20.24±2.03	3.25±0.66	4.52±1.05	144.3±49.5
	T2	40.47±9.67^a	13.09±4.62^a	2.45±1.02^a	6.89±0.74^a	96.4±21.9^a
	T3	51.19±12.56^a	18.92±2.42^a	4.60±0.76^a	7.21±1.46	103.2±27.5^a

表2 两组患者凝血指标、PLT动态变化(±s)

组别		APTT(s)	PT(s)	FIB(g/L)	DD(mg/L)	PLT(×10⁹/L)
存活组
	T0	42.09±9.03	18.48±1.55	1.78±0.32	1.36±0.96	372.3±122.5
	T1	40.59±7.87	17.24±2.69	3.56±0.58	3.05±1.45	214.6±65.2
	T2	36.58±6.45	15.09±1.32	3.86±0.40	5.37±1.04	149.4±21.7
	T3	35.76±3.38	13.92±3.92	5.10±0.90	6.90±1.21	135.6±36.1
死亡组
	T0	65.83±10.03	24.48±1.68	1.26±0.07^a	2.06±0.49	398.7±118.2
	T1	62.95±7.57	20.24±2.03	3.25±0.66	4.52±1.05	144.3±49.5
	T2	40.47±9.67^a	13.09±4.62^a	2.45±1.02^a	6.89±0.74^a	96.4±21.9^a
	T3	51.19±12.56^a	18.92±2.42^a	4.60±0.76^a	7.21±1.46	103.2±27.5^a

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Effect of static suction compound anesthesia on coagulation dysfunction in patients with extra-severe burns

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Effect of static suction compound anesthesia on coagulation dysfunction in patients with extra-severe burns