Diagnosis and treatment of disseminated intravascular coagulation in burn patients

Abstract

The aim — to study the violations of the hemostasis system in the acute period of burn disease in severely burned as a prophylaxis for thrombotic complications and provision of early surgical treatment.Materials and methods. The state of the blood clotting system was studied in 80 patients with deep dermal burns from 20 % to 60 % TBSA in the period from the first to the 14th day after the trauma. The age — 18 to 65 years. The following parameters of hemostasis were investigated: the number of platelets; serum fibrinogen, soluble fibrin, antithrombin III, protein C, partially activated thromboplastin time (APTT), prothrombin index, total fibrinolytic activity of blood plasma.Results and discussion. A moderately prolonged clotting time with the remaining level of platelets and fibrinogen were observed in all patient groups during the first day after the burn injury. The parameters of APTT were lowered on the 1st — 2nd day after the trauma in patients with IST for more than 90 units could have indicated the first phase of DIC syndrome; on the 3rd—5th day, an extension of the APTT was determined, which could have indicated a tendency for bleeding, especially during early operations. The level of antithrombin III was decreased in severely burned patients during the first 3 days after the burn injury, the plasma recalcification time decreased to 45 ± 5.4 s. Patients with extremely severe burns received 1.5 ± 0.3 L of fresh frozen plasma daily for 6.0 ± 1.5 days and also 0.6 ± 0.1 L of plasma for the following 10 days after the injury.Conclusions. Patients with deep common burns have are at high risk for thrombotic complications. Such include an increase in level of fibrinogen (> 5.5 g/L), soluble fibrin (> 4 mg/100 mL), prolongation of APTT (> 45 s), decrease in antithrombin III and protein C (< 75 %), fibrinolytic activity (< 65 %). The hemostasis system has the phase character of its functional state with widespread deep burns. Acceleration of blood coagulation was determined during the first two days after the trauma with the depression of physiological anticoagulants: antithrombin III and protein C. From day 3 — 4, intravascular coagulation corresponds to the hypocoagulation phase with the main inhibitors spending. Correction of the hemostasis system is achieved by fresh­frozen blood plasma prescription at a dose of 10 — 20 ml/kg and direct anticoagulants at a dose of heparin 200 — 400 un/kg until the PTT level reaches 40 — 60 s, the recalciation time is up to 2 minutes, the level of antithrombin III is above 60 — 70 %.