山东 济南军区第91医院(272600)

    王永武 陈存富 原 峰 张志华 吴信金 付冬梅 曹静

    内容摘要 本文采用Sysmex F-800型全自动血液分析仪随机对88例中度以上烧伤住院病人伤后1、3、7、14和21天红细胞七项指标的变化进行了动态观察。结果显示：中度、重度、特重度三组不同伤情严重烧伤病人伤后早期(1～3天)除因血液浓缩而导致RBC、HCH、HGB三项指标增高外(较健康人P<0.05)，其它四项指标MCV、MCH、MCHC、RDW无明显改变(P>0.05)。提示：此期由于患者体内红细胞大量破坏丧失所造成的贫血应归属于正细胞均一性贫血，但七项指标检测无法正确判断此时贫血的发生和程度。然而从伤后第7天开始三组病人前三项指标随病程延长和伤情加重分别出现了不同程度的明显降低(P<0.05或0.01)，且未因外源输血量多少而得到明显改善，与此同时RDW确较正常人出现明显升高(P<0.05或0.01)。由此认为：烧伤后期贫血为正细胞不均一性，其主要原因可能为混合细胞性贫血，即叶酸或B₁₂缺乏的同时伴有缺铁。并据此提出了防治意见。

    关键词 严重烧伤 红细胞指标 贫血 临床意义

    The Clinical Significance of Dynamic Changes in Whole Blood Count and Seven Erythrocytic Indexes of Severely Burnt Patients Wang Yongwu,et al.No.91 Hospital,Jinan Military Region,PLA 272600

    Abstract 88 patients with moderate,severe or exceptionally severe burns had their blood examined using Sysmex F-800 type whole blood analyzer,at days 1,3,7,14 and 21 post burn.At early stage (1-3 days),all the patients had only 3 of the erythrocytic indexes (RBC,HCH,HGB)raised as compared with the healthy persons (P<0.05),while MCV,MCH,MCHC and RDW were not changed.(P>0.05).This indicated that at the early stage,erythrocytes were destroyed in large amount and resulted in homogeneous norcytic anemia. After 7 days,patients with moderate,severe and exceptionally severe burns had their 3 erythrocytic indexes reduced significantly (P<0.05 or 0.01)and could not be improved by blood infusion.At the same time,RDW was greatly increased (P<0.05 or 0.01).So at this later stage,the patients had non-homogeneous norcytic anemia or mixed cell anemia due to deficiency of folic acid or vitamine B₂ and deficiency of iron.The authors presented their idea of the prevention and treatment of anemia on the basis of this research. ......