焦痂切除对大面积烧伤早期凝血、抗凝血系统功能状态的影响

The effect of early escharectomy on coagulative and anticoagulative system in massive burn

目的 探讨焦痂切除对大面积烧伤早期患者凝血、抗凝血系统功能状态的影响。方法 采用ELISA法测定凝血酶原片段 1+2 (F1 + 2 )、纤维蛋白肽A (FPA)、可溶性纤维蛋白单体复合物 (SFMC) ,抗凝血酶 Ⅲ抗原 (AT :Ag)、蛋白C抗原 (PC :Ag) ;采用CA 70 0 0血液凝固仪测定抗凝血酶活性 (AT :A)、蛋白C活性 (PC :A)。结果 患者组F1 + 2 、FPA、SFMC水平显著高于对照组 (P <0 0 1)。患者组AT、PC水平及活性均显著低于对照组 (P <0 0 1) ;在患者组中 ,非早期焦痂切除组F1 + 2 、FPA、SFMC水平均显著高于早期焦痂切除组 (P <0 0 1)。而且 ,非早期焦痂切除组的AT、PC水平及活性均显著低于早期焦痂切除组 (P <0 0 1)。结论 大面积烧伤早期时 ,由于组织和血管内皮的严重损伤导致凝血、抗凝血系统间平衡机制的破坏 ,造成严重的高凝状态 ,这种强烈的血栓形成倾向进一步损伤组织并使创伤加剧。焦痴切除可以在很大程度上控制炎症介质的释放并减少全身炎症反应综合征的发生 。

Objective To investigate the effect of early escharectomy on coagulative and anticoagulative system in massive burn.Methods Prothrombin fragment1+2(F1+2),firbrinopeptide A (FPA),soluable fibrin monosomic compound(SFMC),antithrombin-Ⅲ antigen(AT-Ⅲ:Ag),protein C antigen(PC:Ag),antithrombin activated(AT:A),and protein C activated(PC:A) were detennined in patients and control group.Results The patients' levels of F1+2,FPA,and SFMC were obviously higher than those in control groups(P<0.01),but the level and function of AT and PC were obviously lower(P<0.01).In patients group,the level of F1+2,FPA,and SFMC were obviously higher in patients without early escharectomy than in patients with early escharectomy,and the lever and function of AT and PC were obviously lower.Conclusion In the early stage of massive burn,the coagulative and anticoagulative function were impared by the tissue damaged and vascular endothelia.This results in further tissue damage and truama worse serious.Escharectomy can control the inflammatory mediators release,and decrease SIRS,which is significant to avoid thrombus formation and DIC.