Department of Burn and Skin Repair Surgery, Third Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang 325200, China.
Chin Med J (Engl). 2013;126(17):3334-9.
There are controversies about the use of artificial colloids. This research was aimed to determine the effect of various artificial colloids on blood coagulation in the shock stage of severe burn injury.
Totally, 18 female Ba-Ma mini-pigs were subjected to a 40% total body surface third-degree flame burn under anesthesia. Resuscitation therapy was applied 2 hours after the injury, using the burn shock fluid resuscitation formula commonly accepted in the surgical treatment of burns. The Ba-Ma mini-pigs were randomly assigned to three groups (six pigs in each group): succinylated gelatin group (the artificial colloid used was succinylated gelatin Injection), hydroxyethyl starch group (the artificial colloid used was hydroxyethyl starch (130/0.4)), and allogeneic plasma group (the colloid used was allogeneic plasma). Blood samples were collected from the animals prior to the burn injury and again at intervals of 4, 8, 24 and 48 hours post-injury. The platelet count (PLT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and fibrinogen (Fib) were measured, followed by a statistical analysis of all results.
The PLT of succinylated gelatin group and hydroxyethyl starch group at intervals of 24 and 48 hours were (124.3 ± 52.7), (78.8 ± 16.4) × 10(9)/L and (159.0 ± 62.8), (87.3 ± 32.0)× 10(9)/L respectively. But in the allogeneic plasma group at intervals of 8, 24, and 48 hours were (234.3 ± 52.6), (136.0 ± 47.4), (75.8 ± 31.0) × 10(9)/L. The decrease were all statistically significant (P < 0.05, P < 0.01) when compared to pre-burn ((383.3 ± 77.9), (382.7 ± 65.7), (381.0 ± 49.4)× 10(9)/L). The PLT among the three groups, at all the time points, had no statistical difference (P > 0.05). Compared to pre-burn ((10.8 ± 0.9), (11.4 ± 0.8), (10.6 ± 0.7) seconds), the PT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (14.5 ± 1.5) and (16.2 ± 1.3) seconds, whereas in the allogeneic plasma group at 8 and 24 hours the PT were (13.0 ± 0.9) and (14.5 ± 1.5) seconds, i.e., an increase in the statistical significance (P > 0.01). Statistical significance was observed at 8 and 48 hours between the succinylated gelatin group and hydroxyethyl starch group, and at 48 hours between the hydroxyethyl starch and allogeneic plasma group (P < 0.05). The INR at 24 hours were (1.26 ± 0.13) in the succinylated gelatin group, (1.40 ± 0.11) in the hydroxyethyl starch group, and (1.13 ± 0.07) and (1.26 ± 0.13) at 8 and 24 hours in the allogeneic plasma group. When compared with pre-burn ((0.94 ± 0.08), (0.99 ± 0.07), and (0.92 ± 0.06) seconds), the other groups have increased significantly (P > 0.01). The comparison at 8 and 48 hours between the succinylated gelatin group and the hydroxyethyl starch group, at 48 hours between hydroxyethyl starch group and allogeneic plasma group showed statistical difference (P < 0.01). The APTT of succinylated gelatin group and hydroxyethyl starch group at 24 hours were (13.1 ± 1.1) and (14.6 ± 2.9) seconds. The APTT of the allogeneic plasma group at 4, 8 and 24 hours were (10.9 ± 1.4), (11.8 ± 1.1), and (13.7 ± 1.5) seconds. Compared to pre-burn ((11.5 ± 4.2), (11.2 ± 3.3), (10.1 ± 1.4) seconds), they were statistically significant (P < 0.05). There was no statistical difference in the APTT between the three groups, at all the time points. The Fib of the succinylated gelatin group at 24 and 48 hours were (4.3 ± 0.3) and (4.7 ± 0.2) g/L, (4.1 ± 0.3), and (5.0 ± 0.1) g/L in allogeneic plasma group, and at 8, 24, and 48 hours the Fib for the hydroxyethyl starch group was (2.9 ± 0.4), (4.0 ± 0.5), and (4.6 ± 0.6) g/L. Compared to pre-burn ((2.4 ± 0.2), (2.5 ± 0.3), (2.6 ± 0.5) g/L), they were all statistically significant (P < 0.01). There was no statistical difference in APTT between the three groups, at all time points.
The changes of the indices in blood coagulation during the shock phase of a severe burn injury correlate with the stress response to the burn, rather than to the application of HES (130/0.4) and succinylated gelatin.
人工胶体的应用存在争议。本研究旨在确定严重烧伤休克期不同人工胶体对凝血功能的影响。
18 只雌性巴马小型猪全麻下接受 40%总体表面积Ⅲ度火焰烧伤。伤后 2 小时进行复苏治疗，采用烧伤休克液复苏公式。将巴马小型猪随机分为三组（每组 6 只）：琥珀酰明胶组（使用琥珀酰明胶注射液）、羟乙基淀粉组（使用羟乙基淀粉 130/0.4）和异体血浆组（使用异体血浆）。采集动物伤前及伤后 4、8、24 和 48 小时的血样。测量血小板计数（PLT）、凝血酶原时间（PT）、国际标准化比值（INR）、活化部分凝血活酶时间（APTT）和纤维蛋白原（Fib），并对所有结果进行统计学分析。
琥珀酰明胶组和羟乙基淀粉组伤后 24 小时和 48 小时的 PLT 分别为（124.3±52.7）、（78.8±16.4）×10^9/L 和（159.0±62.8）、（87.3±32.0）×10^9/L，异体血浆组伤后 8、24、48 小时的 PLT 分别为（234.3±52.6）、（136.0±47.4）、（75.8±31.0）×10^9/L，与伤前比较均显著降低（P<0.05，P<0.01）。三组各时间点 PLT 比较差异均无统计学意义（P>0.05）。琥珀酰明胶组和羟乙基淀粉组伤后 24 小时的 PT 分别为（14.5±1.5）和（16.2±1.3）秒，与伤前比较显著延长（P<0.01），异体血浆组伤后 8 小时和 24 小时的 PT 分别为（13.0±0.9）和（14.5±1.5）秒，与伤前比较差异有统计学意义（P<0.01）。琥珀酰明胶组与羟乙基淀粉组间、羟乙基淀粉组与异体血浆组间伤后 8 小时和 48 小时的 PT 比较差异均有统计学意义（P<0.05）。琥珀酰明胶组伤后 24 小时的 INR 为（1.26±0.13），羟乙基淀粉组为（1.40±0.11），异体血浆组伤后 8 小时和 24 小时的 INR 分别为（1.13±0.07）和（1.26±0.13），与伤前比较均显著升高（P<0.01）。三组间各时间点的 INR 比较差异均无统计学意义（P>0.05）。琥珀酰明胶组与羟乙基淀粉组间、羟乙基淀粉组与异体血浆组间伤后 8 小时和 48 小时的 INR 比较差异均有统计学意义（P<0.05）。琥珀酰明胶组和羟乙基淀粉组伤后 24 小时的 APTT 分别为（13.1±1.1）和（14.6±2.9）秒，异体血浆组伤后 4、8 和 24 小时的 APTT 分别为（10.9±1.4）、（11.8±1.1）和（13.7±1.5）秒，与伤前比较均显著延长（P<0.05）。三组间各时间点的 APTT 比较差异均无统计学意义（P>0.05）。琥珀酰明胶组伤后 24 小时和 48 小时的 Fib 分别为（4.3±0.3）和（4.7±0.2）g/L，异体血浆组分别为（4.1±0.3）和（5.0±0.1）g/L，羟乙基淀粉组伤后 8、24 和 48 小时的 Fib 分别为（2.9±0.4）、（4.0±0.5）和（4.6±0.6）g/L，与伤前比较均显著降低（P<0.01）。三组间各时间点的 Fib 比较差异均无统计学意义（P>0.05）。
严重烧伤休克期凝血功能的变化与烧伤应激反应有关，而与 HES（130/0.4）和琥珀酰明胶的应用无关。
