Characteristics Of The Dynamic Changes Of Coagulation Function In Patients With Severe Burn And Its Relationship With Prognosis

Part 1: Characteristics of the dynamic changes of coagulation function in patients with severe burn and its relationship with prognosisObjective: 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-) were already in the deficiency state in both groups on admission. The level of AT- in the survival group recovered gradually during the first week, but in the non-survival group, the deficiency state of AT- 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- deficiency was characterized by the poor outcome of severely burned patients.Part 2: The significance of thrombelastography in the evaluation on coagulation dysfunction in the severely burned patientsObjective: The present study is to distinguish the differences of parameters of thrombelastography and of conventional coagulation function between the severely burned patients and severe trauma patients with coagulation dysfunction, in order to find out the relationship between the parameters of thrombelastography and of conventional coagulation in the different trauma patients.Methods: The retrospective observation method was employed. The parameters of TEG and of conventional coagulation(PT, APTT, etc.) were matched according to the tests taken within the same period of time( 12 hours) in both the severe burn patients and trauma patients. The sensitivity and specificity of the TEG parameters in judging the abnormal coagulation function were observed. In addition, the correlation values were established between the correspondent parameters of TEG and of conventional coagulation function.Results: This study found that the value R was significantly longer in the coagulation dysfunction group than that of normal coagulation function group both in the severely burned patients and severe trauma patients. If the value R superior to normal value( >10 min) was considered as the criteria of coagulation dysfunction, its sensitivity and specificity was 31% and 100% respectively for the burn patients; however, for the trauma patients, the value R lost its significance. The value MA was significantly correlated with the platelet number in the both burn patients and trauma patients. If the value MA inferior to normal value was considered as the criteria of coagulation dysfunction, its sensitivity and specificity was 25 % and 83.3% respectively for the burn patients; and for the trauma patients, The value MA was slightly better than the value R in the diagnosis of coagulation dysfunction. In addition, the valuable parameter for the evaluation of fibrinolysis state in the conventional coagulation test might not exist.Conclusion: For the severed burned patients, the value R was of low sensitivity and high specificity to diagnose the coagulation dysfunction. The value MA was better than the value R to evaluate the coagulation function for the trauma patients. The parameters of TEG could possess the value for evaluating the state of fibrinolysis.