Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
J Trauma Acute Care Surg. 2013 Jun;74(6):1474-9. doi: 10.1097/TA.0b013e3182923193.
The pathophysiology and time course of coagulopathy after major burns are inadequately understood. Our study objectives were to determine whether acute traumatic coagulopathy (ATC) is seen in burn patients at admission and to determine the changes in international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count (PLT), and hemoglobin (Hgb) in the first 7 days after injury.
We conducted a retrospective study of patients with burn injury of at least 15% total body surface area who presented to the University of North Carolina. Data on patient demographics, injury characteristics, and laboratory data (INR, aPTT, PLT, and Hgb) at admission and within the first 7 days after injury were recorded. We defined ATC as INR of 1.3 or greater, aPTT of 1.5 or greater times the mean normal limit, and normal PLT at admission.
We studied the hematologic profile of 102 patients with burn injury of 15% to 100% total body surface area but did not identify a single patient with ATC at admission. The screening hematologic profile at admission was not influenced by burn severity. In the first 7 days after injury, the INR and aPTT were relatively preserved, while the PLT quickly recovered to baseline after an early decline and the Hgb remained stable at around 10 g/dL; all these changes occurred during the time when the burn patients had received large amounts of fluid resuscitation.
The screening hematologic profile of burn patients at admission is normal, and the standard screening assays do not suggest the existence of ATC at admission. While this is a relatively small study, it provides evidence to suggest that ATC is unique to trauma patients.
Prognostic study, level III.
大面积烧伤后凝血功能障碍的病理生理学和时间进程尚未完全阐明。我们的研究目的是确定烧伤患者入院时是否存在急性创伤性凝血病（ATC），并确定损伤后第 1 天至第 7 天国际标准化比值（INR）、部分活化凝血活酶时间（aPTT）、血小板计数（PLT）和血红蛋白（Hgb）的变化。
我们对至少 15%总体表面积烧伤的北卡罗来纳大学患者进行了回顾性研究。记录患者人口统计学、损伤特征以及入院时和损伤后第 1 天内的实验室数据（INR、aPTT、PLT 和 Hgb）。我们将 ATC 定义为 INR 为 1.3 或更高，aPTT 为正常均值的 1.5 倍或更高，且入院时 PLT 正常。
我们研究了 102 例 15%至 100%总体表面积烧伤患者的血液学特征，但在入院时未发现一例 ATC 患者。入院时的筛选性血液学特征不受烧伤严重程度的影响。在损伤后第 1 天内，INR 和 aPTT 相对稳定，PLT 在早期下降后迅速恢复至基线，Hgb 稳定在 10 g/dL 左右；所有这些变化都发生在烧伤患者接受大量液体复苏的期间。
烧伤患者入院时的筛选性血液学特征正常，标准筛选检测不提示入院时存在 ATC。虽然这是一项相对较小的研究，但它提供了证据表明 ATC 是创伤患者特有的。
预后研究，III 级。
