| Background and objective:Nowadays,the mortality of large area burns,which is attribute to shock,acute renel failure,bleeding of the gastro intestinal tract,is decreasing comparing to 10 years ago.With the development of iatrotechnique and instruments,the healing ratio has been raised totally,but SIRS caused by a varies of burns infection,which may lead to burns Sepsis,is still the primary cause of burns death.Eventually,how to diagnose the infections early and recognize sepsis is the key to increase success ratio of critical care.However,in clinical practice,timely diagnosis of burns infection and Sepsis is usually affected on ground that the criteria o f SIRS which is excessively sensitive,scare of specificity and definite infectious area and bactiaria evedence,this situation could be found in a large part of the patients.YongMing,Yao,etc thought that the keys to cause sepsis are immune discoordination and parafunction of blood coagulability.Thus,detecting acute phase protein which has higher sensitivity,such as C-reactive protein,Fibrinogen,has much significance in preventing Sepsis.To this end,this article focuses on the indexes about immune discoordination and parafunction of blood coagulability,that is to say, the law of Oreactive protein and Fibrinogen.Thereby,it can offer some referrance for clinical early diagnosis and preventing the development of systemic inflammatory response syndrome(SIRS).Methods:36 cases of burned patients came from the department of burn surgery of the second affiliated hospital of Kunming medical college.They were in hospital from 2008 July to 2008 November.There were 28 males and 8 females of them.The extent of burned area was 30%-90%TBSA(total body surface area).The mean was 50.2±19.7%TBSA and theⅢ°mean area was 28.0±17.5%TBSA.15 cases of them,which have TBSA≥30%but noⅢ°and operation,are regard as the first severe burns group;21 cases of them,Ⅲ°wound is reconstructed by escharotomy and stamp grafting or microskin grafting plus Dr acellular xenogenic(porcine) skin,are regarded as the second severe burns group.12 of 36 cases,which are conformed to the criterion of SIRS,are the severe-burns-SIRS group; while other 24 cases are regarded as the severe-burns-not-SIRS group.The patients were taken blood samples by definite quantity at 6 am on 1dth,3dth,7dth and 2wth respectively after they had been injured.Among the patients who needed to be operated we added two time points which were at 6 am on the same day and the next day.Addtionally, the 12 cases two-blood-samples of health adults were served as the control group under the circumstances of daun and limosis in human peripheral venous blood.At the same time,one is detceted as CRP,another as FIB. The method of measuring CRP is ELISA,and the later is Immunoturbidimetry.Results:1.The mean of serum CRP of the severe burns 1th and 2th groups are all more significant higher than that of the healthy control group on the 1dth,3dth,7dth and 14dth(P＜0.01);that of serum CRP of the 2th severe burns group is more significant higher than the 1th group on 14dth(P＜0.01).2.The mean of serum FIB of the 1th severe burns group on 1dth has no difference comparing with the healthy control group(P＞0.05),and the 2th group on 1dth has significant difference(P＜0.05);every mean of serum FIB are increasing in 3dth,and it reaches summit on 7dth,which are all more significant higher than that of the healthy control group (P＜0.05);The mean of serum FIB of the severe burns groups have no difference comparing with the healthy control group on 14dth(P＞0.05).3.The mean of serum CRP of the 2th severe burn group on the next day in the postoperation is more significant higher than that of the preoperation(P＜0.05);The mean of serum FIB has no significant difference between postoperation and preoperation.4.Every mean of serum CRP of the severe burns SIRS group has significant difference comparing with the severe burns not-SIRS group on 3dth,7dth and 14dth(P＜0.01);while those of serum FIB have no difference(P＞0.05).Conclusion;1.The change of serum CRP and FIB of the severe burns has a paticular law:The mean of serum CRP has significantly rosen within 24h,while FIB is lower than normal level;both of them reach summits on 3-7dth;on the 14dth,it is true that CRP begins to fall,but still situates on a higher level,morever,it is higher than the has-notⅢ°burn,while FIB is near to normal nevel whatever it hasⅢ°burn or has-notⅢ°burn.2.The mean of serum CRP rises again after postoperation,which may be due to recausing tissue injury after postoperation,while FIB is not affected by the trauma.3.Whether the patients of severe burns complicate SIRS and Sepsis or not could be evaluated by dynamical detecting CRP and FIB,thus we can timely and validly take some therapeutic measures to prevent the conditon getting worse.4.The changing regularity of CRP and FIB in early stage of severe burns may be practised in clinic,that is to say,they may preview early change of severe burns.
|
PDF Full Text Request