严重烧伤患者血液流变学临床研究

The Clinical Research of Hemorheological Changes in 100 Severely Burned Patients

目的探讨血液流变学指标在烧伤治疗过程中的临床意义。方法回顾性研究符合条件烧伤病人100例,其中, 入院诊断烧伤创而为二度、21d内愈合者46例列入A组;入院诊断烧伤创而为二度、因创面进行性损害并感染造成创面加深需清创植皮者22例列入B组;入院诊断烧伤创面三度面积≥5％、需早期清创植皮并于伤后7d内进行手术者32例列入C 组。正常对照组30例列入D组。全部病例在伤后12h内、第3d及第7d各做一次血液流变学指标检测。结果 (1)严重烧伤患者的A、B、C组在伤后12h内的血液流变学指标较正常对照组差异有非常显著意义(P<0．01);而A、B、C 组间差异无显著意义(P>0．05)。(2)伤后第3dA组血液流变学指标较正常对照组差异有显著意义(P<0．05);B、C 组血液流变学指标较正常对照组差异有非常显著意义(P<0．01);A组血液流变学指标与B、C组比较差异有显著意义(P <0.05)。(3)伤后第7dA组血液流变学指标较正常对照组差异无显著意义(P>0．05);B组血液流变学指标较正常对照组差异有非常显著意义(P<0．01);C组血液流变学指标较正常对照组差异有显著意义(P<0．05);A、C组血液流变学指标与B组比较差异有显著意义(P<0．05)。结论对血液流变学指标的动态监测,在严重烧伤治疗过程中,指导及时进行稀释治疗及判断早期手术清创时机具有重要的临床意义,值得临床推广应用。

Objective To explore the clinical significance of Hemorheological changes during treatment of severely burned. Methods 100 severely burned patients were divided into three groups. 46 of them which heal within 21 days were in group A, the other 22 cases with proceeding injury and infection operated needing transplant of skin were in group B, the other 32 cases with thick burns needing transplant of skin in early stage were in group C. And 30 healthy in group D were included. Hemorheological indexes were measured for all patients the 12th hour, the third day and the 7th day after hurned.Results Within the 12th hour, hemorheological indexes were significantly higher in group A, B, C than in group D（P〈0.01）.On the third day, hemorheological indexes were significantly higher in group A than in group D（P〈0.05）,so much higher in group B, C than in group D（P〈0.01）,so significantly higher in group B, C than in group A（P〈0.05）.On the 7th day, hemorheological indexes were significantly higher in group B than in group D（P〈0.01）,so significantly higher in group C than in group D（P〈0.05）,so significantly higher in group B than in group A, C（P〈0.05）. Conclusion Dynamic observation of hemorheological indexes is the important clinical significance in guiding exact hemodilution and determining early operation during treatment of severely burned.