Quantitatively Measuring Some Microelements In Both Blood And Wounds Of Severe Burn Patients To Investigate Their Effects On Wound Healing

ObjectiveRecent studies found that too much or too little microelements just as other nutritional ingredients is harmful to the body.Either lack of or excessive microelements will cause various physiological disorders though they are only trace elements in the body.Wound managements persist in the whole process of treating severe bum patients and there are many factors affecting wound healing,among of which microelements play an important role.The quantitative changes of local or systemic microelements may affect wound healing in result or the length of healing period.At present,there are many studies about the changes of the microelements in sera and urines of the burn patients in the early period postburn(＜4 weeks).Little reports are found about the microelements contents in the blood or granulation tissues in the middle-phase postbum.This study was designed to investigate the possible effects of microelements in wound repair by means of measuring their contents in the blood and wounds of severe bum patients at different stages postbum and induce some new clinical ideas of microelements treatment.Materials and Methods1.Cases Selection:All subjects are gathered from the inhospital cases admitted at Burn Unit of Nanfang hospital from April to October of 2007.38 patients meet the inclusive criteria,consisting of 34 males and 4 females,with a mean age of 34±9 years,sustaining burn injuries of＞30%TBSA or＞10%third degree burn area. Exclusive criteria:(1) Large sized chemical burn;(2) Accompanying severe liver failure,renal failure,and other endocrine system or digestive system diseases;(3) Serious dysfunction of liver,kidney,or other important organs postburn;(4) Long-term occupational exposing to metal elements;(5) Blood hemoglobin level below 90 g/L or albumin level below 30 g/L.The basic data(average age,burn index, hemoglobin level,albumin level) between each group show no significant differences.2.Grouping:According to the time post injury,all subjects were divided into 4-6 weeks(group A),6-8 weeks(group B),8-10 weeks(group C) and control normal group(group D).3.Samples gathering:(1) Blood samples:On the morning of operating day 2ml venous blood was got using a sterilized syringe a blood donor set with satinless steel needle to draw on the empty stomach.Blood samples are placed on the tube with anticoagulant sodium citrate.After stirring evenly placed -70℃ultra-low-temperature refrigerator preservation;(2) Acquiring of tissue samples On the process of Debridement skin graft surgery acquired the wound granulation tissue, about 3×3cm large,Sterile gauze blot exudate,frozen at -70℃refrigerator;(3) The health tissue of control group from fresh adult skin,blood samples from healthy adult volunteers,storage methods same as above.4.Target measurement and the method:Determination the content of iron, copper,zinc,selenium,manganese,cobalt,plumbic in blood and tissue by inductively coupled plasma-atomic emission spectrometry(ICP-AES).5.All the measurement data express as mean±standard deviation((?)±s), Using SPSS 13.0 statistical software to process data and statistical analysis.The comparison of multi-group measurement data using single-factor analysis of variance (One-way ANOVA),when not satisfied with requests of homogeneity of variance is used Tambane's T2 method of multiple comparisons.The dependablity analysis of the trace elements in blood and tissue samples using dual-variance correlation analysis. When P≤0.05 we think there have statistically significant difference.Results1.The variations of microelements in blood:(1) The concentrations of Fe,Co and Pb in the burn team have no significant defferences to that of group D (P＞0.05),and the differences among group A,B,C have no statistically significant (P＞0.05).(2) The concentration of Zn and Mn in group A,B,C are lower than that of group D,and the differences have statistically significant(P＜0.01);Contrast to group D,the concentration of Se and Cu in group A and B have no significant change (P＞0.05),but in group C,it is lower than that of group D,and the differences have statistically significant(P＜0.05).(3)The concentrations of Mn decreased continuously in group A,B and C,and the differences have statistically significant(P＜0.01);the concentration difference of Zn,Se and Cu between group A and group B have no statistically significant(P＜0.05),but both significantly higher than that of group C (P＜0.05).2.The variation of microelements in wounds:(1) The content of Fe,Co and Pb in group A,B,C have no significant differences to that of group D(P＞0.05),and the differences among every group after burn have no statistically significant(P＞0.05).(2) The content of Zn,Mn and Se in group A,B,C are lower than that of team D,and the differences have statistically significant(P＜0.01);but the content of Cu is statistically higher than that of group D(P＜0.05).(3) The concentrations of Zn and Se in group A and B have no significant differences,but both higher than that of group C(P＜0.05). The content of Mn and Cu have no significant changes(P＞0.05).3.By Bivariate correlation analysis of the microelements in the blood and in the wounds,it revealed that:the variations of Zn,Se,Mn,Cu and Pb in the wounds have statistically significant correlation with that in the blood(r_Zn=0.823,P=0.000;r _Se=0.912,P=0.000;r_Mn=0.934,P=0.000;r_Cu=0.786,P=0.000;r_Pb=0.994,P=0.000); but the concentration of Fe and Co in the wounds have no significant correlation with that in the blood(r_Fe=0.131,P=0.432;r_Co=0.107,P=0.521).Conclusion1.The contents of microelements can take place variable changes both in blood and in wound tissue through repairing periods of severe burn patients.2.The concentration of Zn,Se,Mn,Cu all decreased in blood;the concentration of Mn decreased earlier and consistently but the concentration of Zn,Se and Cu decreased slowly.3.The concentrations of Zn,Se and Mn in the wounds are lower than that in normal skin all along,and the later at the disease stage,the more obviously it decrease.The level of Cu is higher than that in normal skin all the time.4.The content changes of Zn,Se,Mn and Cu in the wounds have significant correlation with that in blood.5.There are several reasons lead to the variations of the microelements' content, for exemple,the trace element demand increased,lost continued and the intake deficient,et al.6.Microelements Supplemented by varied ways will be profit to the normal level recovery and be helpful for the wounds healing in time.