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目的观察烧伤患者血浆凝溶胶蛋白水平及变化规律,探讨凝溶胶蛋白水平与患者预后的关系。方法采用前瞻性队列研究的方式,选取2010年1月-2013年6月收治的98例烧伤面积≥30%总体表面积患者作为研究对象,分别按照烧伤面积大小、是否出现脓毒症以及脓毒症患者是否死亡分组,比较不同组别患者血浆凝溶胶蛋白水平及变化趋势。结果伤后7 d患者的血浆凝溶胶蛋白水平处于最低值,与其他时间点比较差异有统计学意义(P<0.001)。血浆凝溶胶蛋白浓度随着烧伤面积增大而降低(P<0.001)。脓毒症患者血浆凝溶胶蛋白总体均数水平低于非脓毒症患者,差异有统计学意义(F=1 035.41,P<0.001)。脓毒症死亡患者血浆凝溶胶蛋白总体均数水平低于存活患者,差异有统计学意义(F=958.69,P<0.001);伤后7~21 d的血浆凝溶胶蛋白水平低于伤后3 d及入院当天,差异有统计学意义(P<0.001)。结论烧伤可导致患者血浆凝溶胶蛋白水平降低,烧伤面积越大、合并脓毒症患者的血浆凝溶胶蛋白越低。血浆凝溶胶蛋白是反映大面积烧伤患者预后的一项重要监测指标。
Objective To observe the plasma level of gelsolin and its variation in patients with burn, and to explore the relationship between the level of gelsolin and the prognosis of patients. Methods A prospective cohort study was conducted in 98 patients with burn area ≥30% of the total surface area admitted from January 2010 to June 2013. The patients were divided according to the size of burn area, sepsis and sepsis Whether the patients were divided into groups according to their death or not, the level of plasma gelsolin and the trend of change in different groups were compared. Results The level of plasma gelsolin was the lowest at 7 days after injury, which was significantly different from other time points (P <0.001). Plasma gelsolin concentrations decreased with increasing burn area (P <0.001). The overall mean plasma levels of plasma gelsolin in patients with sepsis were significantly lower than those without sepsis (F = 1 035.41, P <0.001). The mean plasma levels of plasma gelsolin in patients with sepsis were lower than those in survivors (F = 958.69, P <0.001). The levels of plasma gelsolin in patients with sepsis were lower than those in patients with post-injury 3 d and the day of admission, the difference was statistically significant (P <0.001). Conclusions Burn can lead to a decrease in plasma levels of plasma agglutinin and a greater burned area in patients with sepsis. Plasma gelsolin is an important indicator of the prognosis of large area burn patients.