Review Of Blood Transfusion And The Analysis Of Its Related Factors In Multi-center Extensive Burns

Objective:The clinical data of patients with extensive burns were retrospectively analyzed,and the related factors affecting blood transfusion of patients were discussed in order to provide more detailed reference for the clinical use of blood in burn patients.Methods:This study included patients with large-area burns(total burned area ≥ 50%TBSA)who met the criteria and were admitted to the burn centers of three hospitals from January 1,2016 to June 30,2022: the First Affiliated Hospital of Nanchang University,the Second Affiliated Hospital of Zhejiang University School of Medicine and the First Affiliated Hospital of Anhui Medical University.Basic information,burn condition,surgical condition,infection,treatment,and blood transfusion were collected to analyze related factors of plasma and red blood cell infusion,and surgical data such as cutting scab area,operation time,surgical site,and wound graft were collected to analyze related factors of surgical blood loss.SPSS25.0 software was used for data entry,sorting and analysis.Descriptive statistical analysis,univariate and multivariate analysis were carried out to explore the factors related to blood transfusion in patients with massive burn.Spearman rank correlation analysis was used for continuous variables,Mann-Whitney U test and Kruskal-Wallis H test for type variables,and multiple linear regression analysis was used for multivariate analysis.P < 0.05 indicated that the difference was statistically significant.Results:(1)A total of 455 patients with large area burn who met the inclusion criteria were included.There were 330 males and 125 females,aged(46.33±14.11)years,with the total burn area of 70%(60%,87%)TBSA and the third-degree burn area of33%(16%,55%)TBSA.A total of 1461 scab cutting,debridement or skin grafting operations were performed,with a median of 3(1,5).The total blood transfusion rate during hospitalization was 96.0%(437 cases),and the plasma,red blood cell and platelet transfusion rates were 95.6%,90.1% and 16.0%,respectively.The average plasma infusion was 6350(3050,11650)ml and the average red blood cell infusion was 14(6,27)U.(2)Analysis of factors related to plasma and red blood cell infusion in patients with massive burn:(1)The results of univariate analysis show that Aspiration injury,pulmonary edema,other trauma,Hb value < 70g/L,bloodstream infection,wound infection,lung infection,urinary tract infection,sepsis,ICU admission,mechanical ventilation,continuous renal replacement therapy(CRRT),total burn area,the thirddegree burn area,first blood lactic acid value,first creatinine value,first albumin value,number of operations,surgical blood loss There were statistically significant differences in plasma infusion and red blood cell infusion in patients with large area burn(P < 0.05).In addition,the presence of underlying diseases and prognosis of patients were correlated with the plasma infusion volume of patients with large area burn(P < 0.05),and the gender,age and initial total bilirubin value of patients were correlated with the red blood cell infusion volume of patients with large area burn(P< 0.05).(2)Multiple linear regression results showed that the third-degree burn area,underlying diseases,initial serum creatinine value,pulmonary edema,sepsis,CRRT,number of operations,operative blood loss and prognosis were independent predictors of plasma infusion during hospitalization in patients with massive burn(P < 0.05).Gender,the third-degree burn area,first blood creatinine value,Hb value <70g/L,sepsis,CRRT,surgical blood loss and length of hospital stay were independent predictors of red blood cell infusion during hospital stay in patients with massive burn(P < 0.05).(3)Of the 1461 cases,602 cases underwent scab cutting and skin grafting within14 days after injury were included.The range of blood loss per case was 100～6766ml,with a median of 1268(813,1927)ml.Univariate analysis showed that there were significant differences in the effects of cutting scab area,surgical duration,surgical site and wound graft on surgical blood loss(P < 0.05).At the same time,cutting scab area ≥ 30%TBSA,surgical blood loss increased significantly.Multiple linear regression results showed that scab cutting area,surgical duration and wound graft were independent predictors of blood loss during scab cutting for large burn(P < 0.05).Conclusion:(1)Extensive burn patients’ gender,presence or absence of underlying diseases,the third-degree burn area,first blood creatinine value,presence or absence of pulmonary edema,presence or absence of Hb value < 70g/L,presence or absence of sepsis,presence or absence of CRRT,number of operations,amount of blood loss during operations,length of hospital stay and prognosis,which are important factors affecting the plasma or red blood cell infusion volume of patients.Therefore,in clinical practice,it is not only necessary to strictly grasp the indications of blood transfusion,but also to timely transfusion according to the specific conditions of patients and reasonable adjustment of blood transfusion volume,so as to carry out blood transfusion treatment more scientifically and effectively,maintain blood volume and correct anemia,and thus improve the prognosis of patients.(2)The single scab cutting area was controlled to be less than 30% TBSA,and the operation time was minimized,and the biograft covered the wound,which could effectively reduce the blood loss in large-scale burn scab cutting surgery,thus reducing the blood transfusion volume of patients.