Soedjana Hardisiswo, Bowo Setiagung A, Putri Nandita Melati, Davita Theresia Risa
Head of Division of Plastic Reconstructive and Aesthetic Surgery Department of Surgery, Dr. Hasan Sadikin General Hospital, Padjadjaran University, West Java, Indonesia.
Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, University of Indonesia, Jakarta, Indonesia.
Ann Med Surg (Lond). 2020 Feb 26;52:1-4. doi: 10.1016/j.amsu.2020.02.007. eCollection 2020 Apr.
Tangential excision in burn patients results in blood loss, with an average of 100 ml per 1% total body surface area (TBSA) excised. This substantial blood loss will be accompanied by decreasing serum albumin concentration, increasing inflammation, capillary leakage, and surgical stress. The importance of maintaining albumin level in burn injury is essential for wound healing, decreasing the susceptibility of sepsis, and preventing acute respiratory distress syndrome, the leading causes of death in burn injuries.
This was a prospective cohort study at our plastic surgery center in Bandung, West Java, Indonesia from January 2018. Serum albumin were sampled taken preoperatively and postoperatively after 24 h. Correlation to the percentage of burn tissue excised was analyzed.
Twenty-eight patients with burn injury were enrolled as study subjects. There was a significant drop in serum albumin after tangential excision surgery compared to prior surgery in burn patients with mean reduction of 8.6 ± 7.3% (P-value < 0.05) to the mean postoperative albumin value is 0.15 ± 0.1 g/dL. The albumin drop was correlated with blood loss (r = 0.326, P-value < 0.05) but not with the excision area (r = 0.196), length of surgery (r = -0.077) and TBSA (r = -0.213). Strong correlation was shown between excision area with the amount of blood loss (r = 0.567, P-value = 0.001).
Tangential excision leads to a reduction in postoperative serum albumin concentration. The magnitude of albumin reduction strongly correlated with the amount of blood loss amount during the procedure.
烧伤患者的削痂手术会导致失血，每切除1%的总体表面积（TBSA）平均失血100毫升。这种大量失血会伴随着血清白蛋白浓度降低、炎症增加、毛细血管渗漏和手术应激。在烧伤中维持白蛋白水平对于伤口愈合、降低败血症易感性以及预防急性呼吸窘迫综合征至关重要，而急性呼吸窘迫综合征是烧伤患者死亡的主要原因。
这是一项于2018年1月起在印度尼西亚西爪哇万隆我们的整形外科中心进行的前瞻性队列研究。术前和术后24小时采集血清白蛋白样本。分析其与切除的烧伤组织百分比的相关性。
28例烧伤患者被纳入研究对象。与烧伤患者先前手术相比，削痂手术后血清白蛋白显著下降，平均降低8.6±7.3%（P值<0.05），术后白蛋白平均值为0.15±0.1克/分升。白蛋白下降与失血量相关（r = 0.326，P值<0.05），但与切除面积（r = 0.196）、手术时长（r = -0.077）和TBSA（r = -0.213）无关。切除面积与失血量之间显示出强相关性（r = 0.567，P值 = 0.001）。
削痂手术导致术后血清白蛋白浓度降低。白蛋白降低的幅度与手术过程中的失血量密切相关。
