Objectives: In recent years, it has been reported that the anti-shock effect of plasma substitutes in adult patients with major burn in shock stage is not good. However, due to the shortage of clinical frozen plasma supply, it is impossible to guarantee that frozen plasma is used as colloidal solution for anti-shock treatment. The purpose of this study is to explore the effect of the infusion ration between frozen plasma and plasma substitutes on the prognosis of adult patients with major burn in shock stage.
Methods: This study enrolled 586 adult patients with major burn by selecting the hospitalization burn patients, who had been hospitalized at the Jiangxi province burn center from September 2014 to April 2019. The patients with the infusion ratio of frozen plasma to plasma substitutes ≥2꞉1 at 48 hours after admission were included in the experimental group, otherwise they were included in the control group. The basic clinical data and clinical prognosis indicator in the 2 groups were compared. Logistic univariate regression analysis was used to screen the influential factors of 30-day mortality in adult patients with major burn, and logistic multivariate regression analysis was used to obtain independent risk and protective factors; Kaplan-Meier method was used to draw the survival curve of the 2 groups, and log-rank test was used to compare the 30-day survival rate of the 2 groups.
Results: There were significant differences in the infusion volume of frozen plasma and plasma substitutes between the 2 groups at 48 hours after admission (both P<0.05). The duration of mechanical ventilation in the experimental group was shorter than that in the control group, the percentage of continuous renal replacement therapy (CRRT) in the experimental group was lower than that in the control group, and the in-hospital mortality and 30-day mortality in the experimental group were lower than those in the control group, the differences were statistically significant (all P<0.05). The percentage of burn area and total body surface area (TBSA) was an independent risk factor for 30-day mortality of adult patients with major burn (OR=1.228, 95% CI 1.010 to 1.439, P=0.039), while the infusion ration between of frozen plasma and plasma substitutes 48 hours after admission was an independent protective factor (OR=0.016, 95% CI 0.001 to 0.960, P=0.023). The 30-day survival rate of the experimental group was significantly higher than that in the control group (P<0.001).
Conclusions: Infusion ration between frozen plasma to plasma substitutes at 48 hours after admission is an independent protective factor for 30-day mortality of adult patients with major burn. In the early stage of adult patients with major burn, frozen plasma should be used as the anti-shock therapy as far as possible (frozen plasma꞉plasma substitute ≥2꞉1) to improve the prognosis and reduce the of 30-day mortality.
目的: 近年有研究报道大面积烧伤成年患者休克期使用血浆代用品的抗休克效果不佳，然而由于临床上冰冻血浆供应紧张，无法保障患者在休克期内都有冰冻血浆作为胶体液来进行抗休克治疗，本研究旨在探讨休克期冰冻血浆与血浆代用品输注比例对大面积烧伤成年患者预后的影响。方法: 回顾性分析2014年9月至2019年4月在我院烧伤科住院治疗的586例大面积烧伤成年患者临床资料。入院48 h冰冻血浆与血浆代用品输注比例≥2꞉1的患者纳入实验组，反之则纳入对照组。比较2组患者基本临床资料和预后转归指标，并采用logistic单因素回归分析筛选大面积烧伤成年患者30 d病死率的影响因素，对影响因素进一步行logistic多因素回归分析以得出独立危险因素及保护因素；采用Kaplan-Meier法绘制2组患者的生存曲线并运用log-rank检验比较2组患者30 d生存率。结果: 2组患者入院48 h冰冻血浆及血浆代用品输注量差异均有统计学意义(均P<0.05)。实验组机械通气时间短于对照组，接受连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)百分比低于对照组，且住院死亡率及30 d病死率均低于对照组，差异均有统计学意义(均P<0.05)。烧伤面积/总体表面积(total body surface area，TBSA)是大面积烧伤成年患者30 d病死率的独立危险因素(OR=1.228，95% CI：1.010~1.439，P=0.039)，而入院48 h冰冻血浆与血浆代用品输注比是其独立保护因素(OR=0.016，95% CI：0.001~0.960，P=0.023)。实验组30 d生存率明显高于对照组(P<0.001)。结论: 入院48 h冰冻血浆与血浆代用品输注比例是大面积烧伤成年患者30 d病死率的独立保护因素。大面积烧伤成年患者应早期使用冰冻血浆作为胶体液(冰冻血浆与血浆代用品输注比≥2꞉1)进行抗休克治疗。.
Keywords: 30-day mortality; frozen plasma; infusion ration; major burn; prognosis.