Investigation of internal environment changes and transfusion therapy at early burn stage of severe burn patients (2015)

Objective
To explore the clinical significance of internal environment changes and transfusion therapy at early burn stage of severe burn patients.


Methods
From January 2010 to May 2014, forty-three early extensive severe burn patients who hospitalized in Foshan First People's Hospital of Guangdong Province were enrolled into this study, as study group. Detect the internal environment changes at different time during treatment, such as routine blood test, blood coagulation function, blood gas analysis, blood biochemical indicators and so on. Except of conventional burn treatment, appropriate component transfusion therapy was conducted on patients at the same time, according to its burn surface area and burn degree, volume of surgical hemorrhage, blood oozing from the wound surface and the progression of disease. Analyze the blood transfusion and internal environment changes of early severe burn patients. Forty-three cases of healthy who took health examination in the same hospital during the same period were chose as control group. Statistical analysis was performed on two groups of routine blood test, blood coagulation function, arterial blood gas analysis, blood biochemical indicator and so on. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Foshan First People's Hospital of Guangdong Province. Informed consent was obtained from all participants. There were no significant differences about age and gender between two groups (P>0.05).


Results
① At the early stage of burn, sever burn patients had different degree of coagulation dysfunction. Within one day after burning, the prothrombin time (PT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) of study group were higher than those of control group, and the differences were statistically significant (P<0.05); At the time of admission, thrombin time (TT) of study group was higher than that of control group, and the difference was statistically significant (P<0.05), and at other time during hospitalization it was lower than that of control group, and the difference was statistically significant (P<0.05). Three days after burning, the content of fibrinogen (FIB) of study group was higher than that of control group, and the difference was statistically significant (P<0.05). ② At the early stage, early sever burn patients also had different degree of acidosis. Within one day after burning, the pH value, concentration of whole blood base excess (BE) and HCO3– of study group were all lower than those of control group, and the differences were statistically significant (P<0.05). ③ One day after burning, red blood cell count, level of hemoglobin (Hb), hematocrit (Hct) of study group increased significantly compared with those of control group, and the differences were statistically significant (P<0.05), reflecting the condensed state of blood. And there days after burning, these three indicators decreased compared with those of control group. Within 24 hours after burning, platelet count of study group increased, and the difference was statistically significant (P<0.05), then decreased, and increased again three weeks after burning, and the difference was statistically significant (P<0.05); Within 48 hours after burning, patients with severe burns in study group were transfused plasma in major. And the volume of blood transfusion increased significantly as treatment prolonged, so a variety of blood components were transfused to them, such as red blood cells, platelets and cryoprecipitate. Three days to fourteen days after buring, red blood cell count, level of Hb and Hct of study group improved significantly after transfusion, and the differences were statistically significant (P<0.05).


Conclusions
Monitoring the internal environment changes of severe burn patients dynamically at the early stage of burn and adjusting the treatment plan timely, while giving reasonable transfusion therapy at the same time is the key to successful treatment of severe burn patients.


Key words: 
Burns; Blood transfusions; Coagulation function; Hematologic tests