Department of Burn Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Institute of Burn Research of Inner Mongolia, Baotou, China.
Department of Burn Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Institute of Burn Research of Inner Mongolia, Baotou, China.
Burns. 2023 May;49(3):678-687. doi: 10.1016/j.burns.2022.05.003. Epub 2022 May 12.
Research on coagulation dysfunction following burns is controversial. This study aimed to describe the coagulation changes in severe burn patients by examining coagulation parameters.
Patients with third-degree total body surface area (TBSA) burns of ≥30% were enrolled between 2017 and 2020. Platelet (PLT) count and coagulation indexes (including APTT, INR, FIB, DD, and AT Ⅲ) were measured at admission and once weekly for 8 weeks, and statistical analysis was performed. The patient medical profiles were reviewed to extract demographic and clinical data, including TBSA, third-degree TBSA, and inhalation injury. The total intravenous fluids and transfusions of crystalloids, fresh frozen plasma (FFP), and red blood cells (RBC) were calculated during the forty-eight-hour period. The number of sepsis cases was recorded.
We enrolled 104 patients , and while the overall coagulation trend fluctuated, inflection points appeared around one week and demonstrated hypercoagulability. INR was significantly higher in the non-survival group than in the survivors' group from admission to three weeks after burn (all p<0.01). From post-injury week 1 to post-injury week 3, the APTT in the non-survival group was greater than in the survival group, but the non-survival group's PLT count was lower than that in the survival group (all p<0.05). At two and three weeks after burns, the FIB levels in the non-survival group were significantly lower than those of the survival group (both p<0.01). The prevalence of inhalation injury and the proportion of sepsis cases were significantly higher in the non-survival group than in the survival group ( p ＜ 0.05, p ＜ 0.001, respectively). At the time of death, APTT, INR, and FDP levels were significantly higher in the non-survival group in the survivor group, and FIB, ATIII, and PLT were significantly lower than in the survivor group (all p<0.01). On the day of death, nine of the 12 dead patients had disseminated intravascular coagulation (DIC).
Coagulation dysfunction was most prominent in severe burn patients 1 week after injury and presented as hypercoagulability. Large-area burn injury, large amounts of fluid resuscitation, inhalation injury, and sepsis may all contribute to coagulation dysfunction, which can further develop into DIC and even death in severe burns patients.
关于烧伤后凝血功能障碍的研究存在争议。本研究旨在通过检查凝血参数来描述严重烧伤患者的凝血变化。
纳入 2017 年至 2020 年间，总面积 30%以上三度烧伤的患者。入院时和入院后每周测量血小板（PLT）计数和凝血指标（包括 APTT、INR、FIB、DD 和 AT Ⅲ），并进行统计学分析。回顾患者病历，提取人口统计学和临床数据，包括 TBSA、三度 TBSA 和吸入性损伤。计算伤后 48 小时内晶体和新鲜冷冻血浆（FFP）、红细胞（RBC）的总静脉输液量和输血量。记录脓毒症病例数。
共纳入 104 例患者，整体凝血趋势波动，在伤后一周左右出现拐点，表现为高凝状态。从入院到烧伤后三周，非存活组的 INR 一直高于存活组（均 p＜0.01）。从伤后第 1 周到伤后第 3 周，非存活组的 APTT 大于存活组，但非存活组的 PLT 计数低于存活组（均 p＜0.05）。烧伤后第 2 周和第 3 周，非存活组的 FIB 水平明显低于存活组（均 p＜0.01）。非存活组吸入性损伤和脓毒症的发生率明显高于存活组（p＜0.05，p＜0.001）。死亡时，非存活组的 APTT、INR 和 FDP 水平明显高于存活组，FIB、ATIII 和 PLT 水平明显低于存活组（均 p＜0.01）。死亡当天，12 例死亡患者中有 9 例发生弥散性血管内凝血（DIC）。
严重烧伤患者伤后 1 周凝血功能障碍最为明显，表现为高凝状态。大面积烧伤、大量液体复苏、吸入性损伤和脓毒症均可能导致凝血功能障碍，进而在严重烧伤患者中发展为 DIC，甚至死亡。
