Analysis Of The Blood Transfusion And Influential Factors In Patients With Severe Burns During Perioperation

ObjectiveTo Investigate and analyze the blood transfusion situation and its influencing factors in patients with severe burns during perioperation,in order to provide the clinical reference for reasonable use of blood in severe burned patients.Methods1.Collected the severe burned patients’ basic data from January 2014 to December 2017 of burn and plastic surgery department of Tianjin first central hospital,and selected 55 patients who were survived after accept surgery of tangential excision and skin grafting into the research object of this study.2.Investigated the contents including case number,gender,age,burns causes,specific burn parts,total burn surface area,deep partial-thickness burn area,full-thickness burn area,hospitalization days and other general clinical data.3.Analyzed basic surgery situation of these patients including admission time after injury(hours),operation frequency(eschar excision and skin grafting),operation time(days after injury),excision site and area,donor site and area,intraoperative blood loss(according to the record),and so on.4.Investigated the situation of blood transfusion at perioperation(7 days before surgery and 7 days after surgery),including suspended red blood cells,frozen plasma,platelets,and made statistics of the RBC count,the content of HGB,HCT and the PLT count after 3 days of injury and during the whole perioperation.5.Calculated the total volume range of suspended red blood cells and frozen plasma during intraoperative and perioperation,and the average volume range of suspended red blood cells and frozen plasma per 1% TBSA eschar excision during intraoperative and perioperation.6.Statistics and data were processed using the SPSS 21.0 software.Count data expressed by rate,measurement data normally distributed were showed by mean ± SD,two groups comparison using t test,multiple comparison using single factor ANOVA;Non-normal distribution with median and percentile(P25,P75),two groups comparison using the Mann-Whitney U test,multiple comparison using Kruskal – Wallis H test.The relationship between the two variables by using Pearson correlation and Spearman rank correlation to analysis.The correlation coefficient is represented by r.P < 0.05 was considered statistically significant.Results1.There are 55 cases in this study,including 43 men and 12 women,the average age,total burn area,full-thickness burn area and hospitalization days of 55 patients were 40.5±12.5 years,54.2±11.5 %,41.4±10.1 %,and 65.5±21.5 days,respectively.2.Burn etiology: flame burned 40 cases,scald 8 cases,electrical burns 6 cases,chemical burns 1 case.The burn wounds at limbs,face and trunk were more than other parts.Burn area at the range of 31%TBSA to 50%TBSA were 13 cases,more than 50%TBSA were 20 cases,full-thickness burned area at the range of 11%TBSA to 20%TBSA were 10 cases,full-thickness burned area more than 20%TBSA were 12 cases.23 patients complicated with inhalation injury.3.22 cases accepted surgery within 7 days,23 cases accepted surgery during 7-14 days,10 cases accepted surgery after 14 days.A total of 82 times surgery,average was 1.5±0.6 times;1057% TBSA eschar were excised,the average percentage was 15.2±5.0 % TBSA.4.There was 738.5 U suspended red blood cells infusion in a total of 82 perioperation,average 9.0±2.7 U;422360 ml frozen plasma infusion in a total of 73 perioperation,median 3800 ml(2100,7690).181 U suspended red blood cells infusion in a total of 55 intraoperative,average 3.3±1.0 U;42560 ml frozen plasma infusion in a total of 42 intraoperative,median 600(350,1045)ml.5.The median amount of suspended red blood cells and frozen plasma transfusions during perioperation were 0.70(0.40,1.11)U and 340(200,627)ml per 1%TBSA eschar excision.The average amount of suspended red blood cells and frozen plasma transfusions in Intraoperative were 0.25(0.16,0.40)U and 40(28,80)ml per 1%TBSA eschar excision,which can maintain more than 85% post-operations within 7 days in patients with RBC,HGB,HCT,PLT in the normal reference range.6.Influence factors of suspended red blood cells infusion during perioperation were total burn area(r=0.504,P<0.01),excision site(r=0.436,P<0.01),excision area(r=0.240,P =0.030),donor area(r=0.162,P =0.045)and the volume of blood loss in the operation(r=0.290,P =0.028).Influence factors of frozen plasma infusion during perioperation were total burn area(r=0.250,P =0.024),operation time after injury(r=-0.425,P =<0.01),excision area(r=0.346,P =0.001),donor area(r=0.120,P =0.032)and the volume of blood loss in the operation(r=0.262,P =0.017).ConclusionPatients with severe burns should receive adequate infusion of suspended red blood cells and frozen plasma during perioperation period.We can consider the suspended red blood cells and frozen plasma infusion quantity mainly based on burned patients’ total burn area,operation time after injury,excision area and size,donor area and size,the volume of blood loss in the operation and so on factors.We need to give more suspended red blood cells and frozen plasma When Ⅲ° burn area >30% TBSA,excision area >11% TBSA,and intraoperative blood loss >400 ml.