血浆TM、AT-Ⅲ检测在大面积烧伤削痂术后凝血功能监测中的临床应用

孙涛1 ，张熊2

（1.延安大学咸阳医院检验科，陕西 咸阳，712000；2.咸阳市第一人民医院检验科，陕西 咸阳，712000）

浏览次数：132次 下载次数：345次

摘要：

目的 探讨血浆TM、AT-Ⅲ检测在大面积烧伤削痂术后凝血功能监测中的临床应用价值。方法 选择2014年2月至2016年2月本院ICU收治的大面积烧伤并有削痂手术指征的患者35例，其中早期削痂组19 例，非早期削痂组16 例，并 选取同期本院体检中心健康体检者20例作为对照组，检测三组TM 和AT-Ⅲ水平。结果 早期削痂组休克期尿量高于非早期削痂组，而回收期心率和创面愈合时间均显著低于非早期削痂组（P<0.01）。早期削痂组和非早期削痂组的TM水平分别较对照组明显上调，而AT-Ⅲ水平明显下调，非早期削痂组的TM 水平高于早期削痂组，AT-Ⅲ水平则低于后者（P<0.01）。烧伤 病变发展与血浆TM 和AT-Ⅲ水平具有相关性，且TM 水平及AT-Ⅲ水平均与休克期尿量、回收期心率和创面愈合时间有明显相关性（P<0.01）。结论 大面积烧伤时，由于组织和血管内皮的大面积损伤导致血液的高凝状态，焦痂早期切除可以在很大程度上控制病情发展，预防或缓解血栓形成。

关键词：大面积烧伤；削痂术；高凝状态；血栓形成；TM；AT-Ⅲ

中图分类号：R737.9文献标志码：A文章编号：2096-1413(2017)12-0073-02

Clinical application of plasma TM and AT-Ⅲ detection in monitoring coagulation function after large area burns
SUN Tao 1, ZHANG Xiong 2
(1. Department of Laboratory, Xianyang Hospital of Yan an University；2. Department of Laboratory, the First People s Hospital
of Xianyang, Xianyang 712000, China)

ABSTRACT: Objective To investigate the Clinical application of plasma TM and AT - Ⅲ detection in monitoring coagulation function after large area burns escharectomy. Methods Thirty-five cases of patients with large area burn were selected and divided into early escharectomy group (n=19) and non-early escharectomy group (n=16), and 20 cases of health in the same period of the hospital physical examination center were selected as the control group, the levels of TM and AT-Ⅲ in plasma of the three groups were detected. Results The urine output of shock period of eary escharectomy group was higher than non-early escharectomy group, and the heart rate during recory and wound healing time of eary escharectomy group were significantly lower than those of non-ealy escharectomy group (P<0.01). The levels of TM in the early escharectomy group and the non-early escharectomy group were higher than those of the control group, and that in the non-early escharectomy group was higher than the early escharectomy group, the levels of AT- Ⅲ were lower than those of the control group, and that in the non-early escharectomy group was lower than the early escharectomy group (P<0.01). There was a significant correlation in TM level, AT-Ⅲ level and plasma levels, the levels of TM and AT-Ⅲ with urine output of shock period, heart rate during recovery and wound healing time (P<0.01). Conclusion When the lage area burns happened, the blood hypercoagulable state occured due the to damage of tissue and vascular endothelial, early removal of eschar can be a large extent to control the disease development, prevention or mitigation of thrombosis.

KEYWORDS: large area of burns; tangential excision; hypercoagulable state; thrombosis; TM; AT-Ⅲ

参考文献：
[1] 杨宇,蒋文跃,钱瑞琴.应激对血液流变性的影响及机制[J].中国血液流变学杂志,2000,10(2):72-74.
[2] 陈守万,刘旭盛.烧伤后并发下肢深静脉血栓三例[J].中华烧伤杂志,2005,21(4):288.
[3] 陈聿峰.血栓调节蛋白与冠心病的关系[J].血栓与止血,2014,20(6):347-349.
[4] 李欣,张庆富.烧伤后血栓形成机制和治疗药物[J].微循环学杂志,2013,23(3):70-73.
[5] 陆树良,廖镇江,向军,等.烧伤后24小时内削痂对深域度创面局部炎症反应的影响[J].中华烧伤杂志,2005,21(1):24-26.
[6] 许武红,邹原方,梁翔.血栓调节蛋白升高是维持性血液透析患者心血管疾病的危险因素[J].中国血液净化,2015,14(4):224-226.
[7] LEVIN GY,EGORIHINA MN.The role of fibrinogen in aggregation of platelets in burn injury[J].Burns,2010,36(6):806-810.
[8] 赵永健,门剑龙,刘群.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[J].中华急诊医学杂志,2003,12(10):695-696.