Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China.
Department of Burn Surgery, Institute of Burn Research of Inner Mongolia, The Third Affiliated Hospital of Inner Mongolia Medical University, Baogang Hospital, No. 20 Shaoxian Road, Kundulun District, Baotou 014010, China.
Injury. 2022 Dec;53(12):3993-3999. doi: 10.1016/j.injury.2022.09.061. Epub 2022 Oct 2.
The aim of this study was to retrospectively analyze Thrombelastography (TEG) data of severe burn patients to provide a clinical basis for timely diagnosis and treatment of coagulation dysfunction.
The present study comprised burn patients with full thickness TBSA ≥ 60%. The patients included in the study were admitted to the Third Affiliated Hospital of Inner Mongolia Medical University between March 2019 and March 2022 and died within 10 days. Patient demographic and clinical data, including abbreviated burn severity index (ABSI) score, full thickness and overall total surface burn area (TBSA), injury cause, International Society on Thrombosis and Hemostasis (ISTH) score, were retrieved from the electronic medical record system. TEG data (including ACT, K, α, MA and LY30), platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) data were obtained from the records of included patients for analysis.
A total of 9 patients were enrolled. The average burn area was 90.0% TBSA and the full-thickness TBSA was 72.0%. The results showed that α, MA and PLT count values were significantly lower relative to those at obtained throughout admission period (all p < 0.05). PDW and MPV were significantly higher compared with the values at admission (all p < 0.05). ACT time was significantly longer from day 2 after severe burn compared with the ACT time at admission (all p < 0.05). LY30 value from day 3 after severe burn was significantly higher compared with the value at admission (p < 0.05). One patient was diagnosed with diffuse intravascular coagulation (DIC) on admission, whereas eight patients were diagnosed with DIC on the day of death.
Coagulation dysfunction after severe burn is mainly characterized by procoagulant disorders and hyperfibrinolysis, which can be timely detected by TEG. Coagulation after severe burn exhibits a gradual aggravation, and can lead to death of patients.
本研究旨在回顾性分析严重烧伤患者的血栓弹力图（TEG）数据，为凝血功能障碍的及时诊断和治疗提供临床依据。
本研究纳入全厚 TBSA≥60%的烧伤患者。研究对象为 2019 年 3 月至 2022 年 3 月期间内蒙古医科大学第三附属医院收治的患者，且入院 10 天内死亡。从电子病历系统中提取患者的人口统计学和临床数据，包括简化烧伤严重指数（ABSI）评分、全厚和总体总面积烧伤面积（TBSA）、损伤原因、国际血栓与止血学会（ISTH）评分。从纳入患者的记录中获取血栓弹力图（TEG）数据（包括 ACT、K、α、MA 和 LY30）、血小板计数（PLT）、平均血小板体积（MPV）和血小板分布宽度（PDW）数据进行分析。
共纳入 9 例患者，平均烧伤面积为 90.0%TBSA，全厚 TBSA 为 72.0%。结果显示，与整个住院期间获得的数值相比，α、MA 和 PLT 计数值明显降低（均 p<0.05）。与入院时相比，PDW 和 MPV 值明显升高（均 p<0.05）。与入院时的 ACT 时间相比，严重烧伤后第 2 天的 ACT 时间明显延长（均 p<0.05）。与入院时相比，严重烧伤后第 3 天的 LY30 值明显升高（p<0.05）。1 例患者入院时诊断为弥漫性血管内凝血（DIC），8 例患者死亡当天诊断为 DIC。
严重烧伤后凝血功能障碍主要表现为促凝障碍和纤溶亢进，TEG 可及时检测到。严重烧伤后的凝血呈进行性加重，可导致患者死亡。
