A Clinical Study Of Platelet Changes In Especially Severe Burn Patients

Background: At home and abroad , the study of recent decades has found that platelets changes have close relationship with diseases and drugs .we have found that platelets in severe burn patients would decline in the early clinical stage, platelet changes can reflect the diseases 'development and prognosis at some extent.So, in order to better learn the disease 's conditions by platelet changes, we need to know what factors affect the platelet changes in severe burn patients, we have found that many factors affect the platelet changes, and current literatures that reported studied unilateral factors that affcet the platelet changes, Lacked of system study multiple factors affcet the platelet changes. At clinical work, we have discocered that the platelet changes in severe burn patients is a result of a combination of factors(anisodamine,admission time,burned reasons, total burn surfaces area ,III°burn surfaces area, sepsis, shock, inhalation injury and etc)that affect. this paper draws the statistical conclusions by analysing the cases. to comprehensivly analysing the factors and clinical significance of the platelet changes in severe burn patients;to explore changes and correlations during platelet 's parameters; to further elaborate the platelet's role in prognosis by comparative study on the platelets between the died and survival of severely burn patients. so.we can better understand patient's condition by platelet 's changes and provide the basis for clinical work.Objective: Analysising factors as plateleas's parameters ,anisodamine using admission time,burn reasons, total burn surfaces area ,III~°burn surfaces area, sepsis, shock, inhalation injury,outcome ,burn reasons of 122 cases of previous severe burn patients, comprehensivly study the factors that affect platelet changes in severely burn patients and clinical significance. explore the law of changes over time and correlations during platelet 's parameters; further confirmed the role on the prognosis of platelet in severe burn patients.Methods: 122 severe burn cases.from January 1, 2006 to April 1, 2010 (children's≥30%TBSA, the adults'≥70%TBSA) were collected ,we analysis factors that platelet 's parameters, anisodamine using,admission time,burn reasons, total burn surfaces area ,III°burn surfaces area, sepsis, shock, inhalation injury,outcome ,burn reasons, and etc . And then use SPSS 16.0 to do multi-line analysising. Measurement datas are showed as (mean±standard deviation)((X|-)±s);compare two groups' datas by using 2 independent sample test,and reflect the observed datas of two groups by using statistical bar graph;Compare among groups using by one-way Anoa,two-two comparison is used LSD; Correlation analysis: use Person correlation coefficient for bivariate normal distribution datas; use Spearman correlation coefficient for non- bivariate normal distribution.use all variables regression analysis to explore factors that affect platelet.if p <0. 05 means that the difference is statistically significant.then randomly select normal physical examination results of 40 people, analyze platelet parameters reach the statistical conclusionsResults:1. PLT has significant negative correlation with admission time(r= -0.049, p= 0.046<0.05﹚。2. There is no significant difference between shock group and non-shock group.[Shock group (261.39±211.52)×10~9 / L; non- shock group (279.67±209.92)×10~9 / L, t = -1.27 p = 0.25> 0.05].3. Sepsis group has significantly lower PLT than non-sepsis group.[Sepsis group (206.41±197.25)×10~9 / L, without sepsis group (302.38±210.30)×10~9 / L, t = -6.588 p = 0.00]4.Inhalation injury group has significantly lower PLT than non-inhalation injury group PLT. [inhalation injury group (233.91±144.91)×10~9 / L; non-inhalation injury group (333.84±222.71)×10~9 / L. t = -6.606 p = 0.00 <0.05]. 5. No using anisodamine group has significantly lower PLT than using anisodamine group. [Using anisodamine group (238.97±198.86)×10~9 / L, No using anisodamine group (323.67±221.16)×10~9 / L. T = -0.65 p = 0.00 <0.05]6. The total burn surfaces area has negative correlation with the PLT (r= -0.3,p =0.00); III°burn surfaces has negative correlation with the PLT ( r=-0.077,p=0.024<0.05).7. Make PLT as the dependent variable; make admission time,sepsis, inhalation injury ,anisodamine using ,burn reasons, III°burn surfaces area and total burn surfaces area as independent variables , then, do Multiple line linear regression analysis,we discover:when admission time is longer, III°burn surfaces area and total burn surfaces are bigger ,severe burn patients have sepsis and inhalation injury, have not used anisodamine;the PLT will be lower.8. PLT has significant positive correlation with PCT( r = 0.117, p = 0.01); PLT has significant negative correlation with MPV (r = -0.424, p = 0.000); PLT has significant negative correlation with PDW(r = -0.295, p = 0.000); MPV has significant positive correlation with PDW. (r = 0.251, p = 0.000); PCT has no obvious correlation with MPV and PDW (p> 0.05).9. At 10-15th days of hospitalization time ,PLT always stays at a higher level than normal range of state .10. At different measurement time, the survival group has higher PLT than the death group 's; especially at the 3-7th days of hospitalization time, the survival group has significantly higher PLT than the death group 's (p<0.05);At the 5-15th days of hospitalization time ,the death group 's PLT is in rising state;but at the 9-11th days of hospitalization time, there has a phenomenon that PLT been rising after decreasing.Conclusion: 1.For the patients taken to hospital within 24 hours after injury,when the admission time is longer,the PLT will be lower. 2.Both sepsis and inhalation injury can decrease PLT, but anisodamine prevent it from decreasing.3.The III°burn surfaces area and total burn surfaces area have negative correlation with the PLT,when they are bigger,the PLT will be lower.4. Platelet parameters have correlations with each other: PLT has significant positive correlation with PCT; PLT has significant negative correlation with MPV; PLT has significant negative correlation with PDW; MPV has significant positive correlation with PDW; PCT has no obvious correlation with MPV and PDW.5. Platelet 's changes can be used as early warning indicators to judge the prognosis of severe burn patients: at the 5th days of hospitalization time later,,the platelets decline again in the recovery process;the PLT is less than(97.54±54.15)×10~9 /L, these phenomenons make us to keep alert that patient would die.