特重度烧伤患者凝血功能动态变化特点及与预后的关系

Characteristics of the dynamic changes of coagulation function in patients with severe burn and its relationship with prognosis

目的：动态观察特重度烧伤患者凝血功能的动态变化，探讨特重度烧伤患者凝血功能障碍的特点及其与预后的关系。方法以回顾性观察研究的方法，对在同一时间段收入ICU的15例特重度烧伤患者作为研究对象。根据患者90 d存活与否分为存活组和死亡组，动态观察28 d两组患者一般临床特征和凝血相关指标的变化特点。结果入ICU后第1、2天两组患者的凝血酶原时间（ PT）和活化部分凝血活酶时间（ APTT）均明显延长，并且死亡组较存活组更加明显（P＜0．05）。在入院时两组患者抗凝血酶Ⅲ（AT－Ⅲ）水平均明显低于正常下限，存活组患者1周内渐恢复至正常水平，而死亡组患者持续处于低水平状态。入院时两组患者的血小板计数均明显升高，超过正常上限；此后急剧下降呈低下状态，1周后逐渐恢复接近正常水平。结论特重度烧伤患者凝血功能早期出现明显异常，表现低凝状态伴有血小板减少。 AT－Ⅲ持续低下是严重烧伤患者预后不良的特征之一。

Objective The aim of present study was to find out the characteristics of coagulation function , and to investigate the relationship between the coagulation dysfunction and the prognosis in the critically burned patients .Methods The retrospective observation study was employed .According to the outcome of 90-day-mortality, 15 severe burn patients were divided into 2 groups, survival and non-survival groups . The number of platelet and the parameters of coagulation function were dynamically observed during 28 days following heat injury . Results In the first two days after admission, the parameters of coagulation , prothrombin time （ PT） and activated partial thromboplastin time （ APTT） , were significantly prolonged in both groups , and also these two parameters in non -survival group were longer than those of survival group （P〈0.05）.The Antithrombin Ⅲ （AT-Ⅲ） were already in the deficiency state in both groups on admission .The level of AT -Ⅲ in the survival group recovered gradually during the first week , but in the non-survival group , the deficiency state of AT-Ⅲ was persistent till the end of observation period .Although the level of platelet number was dramatically elevated on admission , the state of thrombocytopenia in both groups was persistent for the subsequent week .Conclusion The coagulation dysfunction exists at early phase of severely burned patients, and mainly appears as the state of coaguplopathy , along with thrombocytopenia; and the sustained state of AT-Ⅲdeficiency is characterized by the poor outcome of severely burned patients .