总白细胞计数的减少与严重烧伤后的急性损伤有关
Julie A Rizzo1,2, Jason M Thomas1,2, James K Aden1
1Brooke Army Medical Center, Fort Sam Houston TX, USA.
概括
烧伤后白细胞计数 (WBC) 的显著下降可能表明急性损伤 (AKI) 和肌球蛋白尿的风险增加. 这种早期白血病,虽然没有影响7天的存活率,但需要进一步调查及时干预.
科学领域:
- 创伤和烧伤关键护理的关键护理
- 腎臟醫學 腎臟醫學
- 血液学 血液学 血液学
背景情况:
- 白细胞症是由于系统性炎症导致的烧伤的常见反应.
- 虽然烧伤后72-96小时全白细胞计数 (TLC) 的下降是典型的,但早期白血病 (<72小时) 描述不好.
- 了解TLC的早期变化可能会揭示与复苏需求和结果的关联.
研究的目的:
- 确定烧伤后早期,极度减少的白细胞总数 (TLC) 是否与增加的液体复苏需求有关.
- 调查早期TLC降低和复苏相关并发症之间的关系,包括急性损伤 (AKI) 和肌球蛋白尿.
- 评估烧伤患者早期TLC降低和7天生存率之间的关联.
主要方法:
- 来自Burn Navigator数据库的295名烧伤患者 (>20%TBSA,>40kg) 的分析,他们使用临床决策支持系统进行了复苏.
- 根据入院后TLC的减少,患者被分为两组:>15,000细胞/μL与<15,000细胞/μL.
- 收集的数据包括人口统计,复苏量,并发症 (肌红蛋白尿,AKI) 和7天生存率,并对TBSA进行调整.
主要成果:
- 在TLC下降>15,000细胞/μL的患者有显著更高的全厚烧伤率和更大的TBSA.
- 超过15,000个细胞/μL的TLC下降与在48小时内接受肌球蛋白尿和AKI的发生率明显增加有关,即使在TBSA调整后也是如此.
- 当对TBSA进行调整时,七天生存率在两组之间没有显著差异.
结论:
- 在烧伤患者中,白细胞计数 (WBC) 在治疗后至少减少15,000个细胞/μL,这与早期的AKI和肌球蛋白尿增加有关.
- 早期白血病和不良结果 (如AKI和肌球蛋白尿) 之间的这种关联需要进一步调查.
- 未来的研究应该探索这种观察到的关联的潜在早期干预和潜在早期干预的潜在机制.
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