焦痂切除对大面积烧伤患者血栓并发症的预防

Observation on Escharectomy in Prevention of Thrombotic Complications in Patients with Large-area Burns

目的观察焦痂切除对大面积烧伤患者血栓并发症的预防。方法选取2013年4月至2014年12月我院收治的大面积烧伤患者60例为研究对象,采用随机数表法分为观察组和对照组各30例,对照组入院后立即进行深静脉置管,并给予乌司他丁及生理、心理干预,观察组在此基础上实施焦痂切除术,记录两组创面愈合时间、住院时间、补液量,分析凝血酶原片段1+2(F_(1+2))、纤维蛋白肽(FPA)及抗凝血酶活性(AT)、蛋白C活性(PC),并观察并发症发生率。结果观察组创面愈合时间(25.18±1.44)d、住院时间(8.73±1.05)d与对照组比较明显较短(P<0.05),观察组补液量(2.14±0.55)L低于对照组(P<0.05);观察组F1+2(1.03±0.14)nmol/L、FPA(2.34±0.57)μg/L、TNF-α(0.14±0.06)ng/ml、IL-6(0.64±0.05)ng/ml较对照组低(P<0.05),观察组AT活性(71.63±1.21)%、PC活性(82.31±1.25)%明显高于对照组(P<0.05);观察组并发症发生率6.7%低于对照组26.7%(P<0.05),两组血栓并发症发生率3.3%、20.0%比较亦有统计学意义(P<0.05)。结论焦痂切除可有效预防大面积烧伤患者血栓并发症,改善其凝血功能,值得在临床推广应用。

Objective To observe escharectomy in prevention of thrombotic complications in patients with large-area burns. Methods Sixty patients with large-area burns admitted to our hospital between April 2013 and December 2014 were selected as the study subjects. By the random number table method, they were divided into observation group and control group, 30 cases in each. The control group was treated with deep vein catheterization immediately after admission, and Was given ulinastatin, physiological and psychological intervention. On the basis, the observation group was treated with escharectomy. The wound healing time, hospitalization time and fluid infusion volume of the two groups were recorded. Prothrombin fragment 1 ＋ 2 （F1＋2 ）, fibrin peptide （FPA）, antithrombin（AT） activity and activity of protein C （PC）were analyzed and the incidence of complications was observed. Results The wound healing time [ （25.18 ± 1.44 ） d ] and hospitalization time [ （8.73 ± 1.05 ）d ] of observation group were significantly shorter than the control group （P 〈 0. 05 ）. The fluid infusion volume [ （2. 14 ± 0. 55 ） L ] was less than he control group （ P 〈 0.05 ）. F1 ＋ 2 （ 1.03 ＋ 0. 14） nmol/L, FPA （ 2.34 ± 0.57 ） p.g/L, TNF- α （ O. 14 ± 0. 06 ） ng/ml and IL- 6 （ 0.64 ± O. 05 ） ng/ml in the observation group were lower than those in control group （P 〈 0. 05 ）. AT activity （71.63 ± 1.21 ）% and PC activity（ 82. 31± 1.25 ） % were significantly higher than those in the control group （ P 〈 0. 05 ） ; The incidence of complications in observation group （6.7 % ）was lower than that in the control group （26.7 % ） （P 〈 0. 05 ）. The difference in the incidence of thrombotic complications between the two groups （3.3% vs 20. 0% ）was significant （P 〈 0. 05 ）. Conclusion Escharectomy can effectively prevent thrombotic complications in patients with large-area burns, and improve the coagulation function. It is worth clinical application.