بررسي رابطه اسكاركتومي بر افزايش پلاكت خون و پيش آگهي بيماران مبتلا به سوختگي حاد

The effect of Escharectomy on Platelet Count and the Prognosis of Extensive Burn Patients

زﻣﯿﻨﻪ و ﻫﺪف: ﺗﻐﯿﯿﺮات ﻫﻤﺎﺗﻮﻟﻮژﯾﮑﯽ ﺑﺴﯿﺎري در ﺑﯿﻤﺎران ﺳﻮﺧﺘﮕﯽ ﺷﺪﯾﺪ رخ ﻣﯽدﻫﺪ. ﯾﮑﯽ از اﯾﻦ ﺗﻐﯿﯿﺮات، ﺗﺮوﻣﺒﻮﺳﯿﺘﻮﭘﻨﯽ اﺳﺖ ﮐﻪ در ﻃﯽ درﻣﺎن ﺳﻮﺧﺘﮕﯽ وﺳﯿﻊ ﺑﻪ دﻻﯾﻞ ﻣﺨﺘﻠﻒ از ﺟﻤﻠﻪ ﻋﻔﻮﻧﺖ اﻣﮑﺎن دارد ﺑﻪ وﻗﻮع ﭘﯿﻮﻧﺪد. ﺷﻤﺎرش روزاﻧﻪ ﭘﻼﮐﺖ در ﺗﺸﺨﯿﺺ زود ﻫﻨﮕﺎم ﻋﻔﻮﻧﺖ و ﻋﻮارض ﺛﺎﻧﻮﯾﻪ ﺑﻌﺪ از ﺳﻮﺧﺘﮕﯽ ﺑﺮاي ﺷﺮوع درﻣﺎن ﻣﺆﺛﺮ ﺑﺴﯿﺎر اﻫﻤﯿﺖ دارد. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺎ راﺑﻄﻪ اﺳﮑﺎرﮐﺘﻮﻣﯽ ﺑﺮ اﻓﺰاﯾﺶ ﺗﻌﺪاد ﭘﻼﮐﺖ ﺑﯿﻤﺎران ﭘﺲ از ﻋﻤﻞ ﺟﺮاﺣﯽ و ﻫﻤﭽﻨﯿﻦ ﮐﺎﻫﺶ ﻣﯿﺰان ﻣﺮگ و ﻣﯿﺮ ﺑﯿﻤﺎران را ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار دادﯾﻢ. ﻣﻮاد و روش ﻫﺎ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﯽ ﺑﺮ روي 52 ﺑﯿﻤﺎر ﺑﺎ ﻣﯿﺰان 40 ﺗﺎ 50 درﺻﺪ ﺳﻮﺧﺘﮕﯽ ﮐﻪ ﺑﻪ ﻣﺮﮐﺰ درﻣﺎﻧﯽ ﺷﻬﺪاي ﯾﺎﻓﺖ آﺑﺎد ﻣﺮاﺟﻌﻪ ﮐﺮده ﺑﻮدﻧﺪ، اﻧﺠﺎم ﺷﺪ. دادهﻫﺎي آزﻣﺎﯾﺸﮕﺎﻫﯽ ﮐﻪ ﺑﻪ ﻃﻮر روزاﻧﻪ اﻧﺪازهﮔﯿﺮي ﻣﯽ ﺷﺪ ،ﺑﻪ وﯾﮋه ﺗﻌﺪاد ﭘﻼﮐﺖ ﺑﯿﻤﺎران در روز اﺳﮑﺎرﮐﺘﻮﻣﯽ ﺛﺒﺖ ﮔﺮدﯾﺪ. از ﺗﺴﺖ آﻣﺎري ﺗﯽ زوﺟﯽ و ﯾﺎ ﻣﻌﺎدل ﻏﯿـﺮﭘﺎراﻣﺘﺮﯾﮏ آن ﺑﺮاي ﻣﻘﺎﯾﺴﻪ ﺗﻌﺪاد ﭘﻼﮐﺖ در ﻫﺮ ﮔﺮوه ﻗﺒﻞ و ﺑﻌﺪ از ﺟﺮاﺣﯽ و از ﺗﺴﺖ آﻣﺎري ﺗﯽ ﻣﺴﺘﻘﻞ و ﯾﺎ ﻣﻌﺎدل ﻏﯿﺮﭘﺎراﻣﺘـﺮﯾﮏ آن ﺑﺮاي ﻣﻘﺎﯾﺴﻪ اﺧﺘﻼف ﺑﯿﻦ ﭘﻼﮐﺖ ﻗﺒﻞ و ﺑﻌﺪ از ﻋﻤﻞ ﺟﺮاﺣﯽ ﺑﯿﻦ ﮔـﺮوهﻫﺎ اﺳﺘﻔﺎده ﺷﺪ و ﺗﻤـﺎﻣﯽ ﻧﺘﺎﯾﺞ ﺑﻪ وﺳﯿﻠﻪ ﻧﺮماﻓﺰار آﻣﺎري SPSS 16.0 ﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ ﺑﯿﻤﺎران 16/70 ± 29/69 ﺑﻮد. 74 % ﻣﻮارد )38 ﻧﻔﺮ( ﺑﻬﺒﻮدي ﭘﯿﺪا ﮐﺮده و ﺗﺮﺧﯿﺺ ﺷﺪهاﻧﺪ و 14) %26 ﻧﻔﺮ( از ﮐﻞ ﺟﻤﻌﯿﺖ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻓﻮت ﮐﺮدهاﻧﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻧﺮﻣﺎل ﺑﻮدن ﺗﻮزﯾﻊ، از آزﻣﻮن ﺗﯽ ﻣﺴﺘﻘﻞ ﺑﺮاي ﻣﻘﺎﯾﺴﻪ اﺧﺘﻼفﻫﺎ اﺳﺘﻔﺎده ﺷﺪ ﮐﻪ اﺧﺘﻼف ﻣﻌﻨﺎدار ﻧﺒﻮد )0.091=P(. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: از ﻣﻘﺎﯾﺴﻪ ﯾﺎﻓﺘﻪﻫﺎ ﻣﯽﺗﻮان ﻧﺘﯿﺠﻪ ﮔﺮﻓﺖ ﮐﻪ ﻋﻤﻞ ﺟﺮاﺣﯽ اﺳﮑﺎرﮐﺘﻮﻣﯽ در ﻫﻤﻪ ﺑﯿﻤﺎران ﺳﻮﺧﺘﮕﯽ، ﭼﻪ آﻧﻬﺎﯾﯽ ﮐﻪ ﻓﻮت ﻣﯽﮐﻨﻨﺪ و ﭼﻪ آﻧﻬﺎﯾﯽ ﮐﻪ زﻧﺪه ﻣﯽﻣﺎﻧﻨﺪ ﺑﺎﻋﺚ اﻓﺰاﯾﺶ ﭘﻼﮐﺖ ﻣﯽﺷﻮد. اﻣﺎ اﯾﻦ اﻓﺰاﯾﺶ ﭘﻼﮐﺖ در ﻫﺮ دو ﮔﺮوه ﻣﻌﻨﯽدار ﻧﺒﻮده و ﻧﻤﯽﺗﻮاﻧﺪ ﺑﻪ ﻋﻨﻮان ﯾﮏ ﺗﻌﯿﯿﻦ ﮐﻨﻨﺪه ﭘﯿﺶآﮔﻬﯽ و ﻣﺮگ و ﻣﯿﺮ، ﻣﻄﺮح ﺑﺎﺷﺪ.

Introduction & Objective: Multiple hematological changes occur in patients with severe burns. One of these changes is thrombocytopenia that may occur during the treatment of extensive burns for various reasons, including infection. Daily monitoring of platelet count is important in the early detection of infection and secondary complications after extensive burns. In this study, we have evaluated the effects of escharectomy on the platelet counts and the reduction of the mortality rate of extensive burn patients. Materials & Methods: This cross-sectional study was done on 52 patients with 40-50% burn who were referred to the Shohadaye Yaft Abad hospital. Laboratory data were measured daily, especially platelet count per day were recorded. The platelet count was measured before and after escharectomy in all patients. Paired t test used to compare parametric or equivalent platelet count in both groups before and after surgery and to compare parametric independent t-test or equal to the difference between the platelets before and after surgery were analyzed between groups and all results were analyzed by SPSS 16.0 statistical software. Results: The patients’ mean age was 29.69 ± 16.70 standard deviation. Of these 74% (38 patients) were treated and discharged, but 26% (14 people) of the population died. Given the normal distribution, independent t-test was used to compare the differences which were found to be of no significance (P = 0.091). Conclusions: From the results, it can be concluded that escharectomy surgery in burn patients, both cases of those who died and those who survived, increases the platelet count. But this increase was not significant in either group and can not serve as a determinant of prognosis and mortality.