| Objective: As the phenomenon of an ageing society in our country is getting worse,more and more elderly patients suffering from basic diseases such as hypertension and diabetes and receiving antithrombotic therapy have begun to receive surgical treatment,and have become a high-risk group for perioperative stroke.Embolism is currently recognized as the key link in the occurrence of stroke,and the hyper coagulant state of surgical patients caused by various reasons is one of the important reasons for perioperative thrombosis and cerebral vascular obstruction.Establishing the correlation between coagulation function and perioperative stroke will have important clinical value for early warning of the occurrence of perioperative stroke.Thrombelastogram(TEG)can accurately assess the coagulation profile of patients.This study aims to use TEG to monitor the coagulation function of people at high risk of perioperative stroke and explore the value of TEG coagulation parameters in early warning of the risk of perioperative stroke.Methods: This study included 220 patients at high risk of perioperative stroke(modified Essen score ≥3)who underwent non-cardiac and non-neurosurgical operations at Yijishan Hospital of Wannan Medical College from December 2019 to March 2021.Another 40 patients who received non-cardiac and non-neurosurgical operations and were not at high risk of perioperative stroke(modified Essen score < 3)were selected as controls.The patients at high risk of perioperative stroke were screened by the modified Essen score before surgery,and the basic data of the patients were collected,including age,gender,BMI,underlying disease status,blood routine indexes,blood coagulation routine and TEG coagulation parameters.The incidence and mortality of stroke and other adverse cardiovascular events in hospital,1 month and 3months after surgery were observed.Results: 1.Comparison of general data between patients at high risk of perioperative stroke and patients in the control group: This study included 220 patients in the high-risk group of perioperative stroke(modified Essen score ≥ 3 points)and 40 patients in the control group(modified Essen score < 3 points).Among the patients in the high-risk group of perioperative stroke,114 were male patients and 106 were female patients,with an average age of(75.43±6.48)years and a BMI of(22.54±3.56)kg/m~2;In the control group,there were 20 males and 20 females,with an average age of(44.23±10.37)years and a BMI of(21.45±1.90)kg/m~2.2.(1)Compared with the TEG parameters of the control group,the TEG parameters of the high-risk group of perioperative stroke patients presented a high coagulation state,the R-value and K value decreased,the α Angle,MA value and CI value increased,the difference was statistically significant(P < 0.05).(2)Compared with the conventional coagulation index and platelet(Plt)count in the control group,There was no significant difference in APTT and platelet(Plt)counts in the conventional coagulation index of patients with perioperative stroke(P>0.05),The PT value,Fib value,INR value and D-D value of high-risk group were higher than those of control group,the differences were statistically significant(P<0.05).3.(1)The TEG parameters of the carotid artery plaque group and patients without carotid artery plaque group were compared,and there was no statistical significance in the TEG coagulation parameters between the two groups(P> 0.05).(2)Comparison of routine coagulation index,platelet(Plt)count and blood glucose index between carotid plaque group and non-carotid plaque group showed that APTT value and platelet(Plt)count in carotid plaque group was higher than that in non-carotid plaque group,and the difference statistically significant(P< 0.05),there was no significant difference in other indexes(P> 0.05).4.Correlation analysis was conducted between TEG parameters of patients with high risk of stroke during perioperative period and conventional coagulation indexes,Plt and Glu and other parameters: R value was positively correlated with APTT(r=0.202,P=0.003).K was negatively correlated with fibrinogen(Fib)content(r=0.231,P=0.001)and platelet(Plt)count(r=0.198,P=0.003).α Angle was positively correlated with fibrinogen(Fib)content(r=0.212,P=0.001)and platelet(Plt)count(r=0.210,P=0.002).MA value was positively correlated with fibrinogen(Fib)content(r=0.506,P=0.000)and platelet(Plt)count(r=0.316,P=0.000).There was no obvious correlation between blood glucose level and TEG parameters.5.Among patients at high risk of perioperative stroke,the α Angle,MA and CI values of TEG parameters in the high D-dimer group were higher than those in the normal D-dimer group,and the K value in the high D-dimer group was lower than that in the normal D-dimer group,the difference being statistically significant(P< 0.05).6.The included 220 patients at high risk of perioperative stroke were followed up in a hospital,one month and three months after the operation.No patients with stroke and other adverse cardiovascular events were found.Conclusion: 1.Patients at high risk of perioperative stroke have a high coagulation state before the operation,TEG can identify the preoperative coagulation state of these patients in time and effectively.2.Among patients at high risk of perioperative stroke,there are no significant differences in TEG parameters between patients with carotid plaque and patients without carotid plaque.3.There is a certain correlation between TEG parameters and coagulation routine indexes in patients at high risk of perioperative stroke.4.Among patients at high risk of perioperative stroke,TEG parameters are significantly different between patients with higher D-dimer and those with normal D-dimer.5.More large-sample clinical studies are needed to confirm whether TEG plays an early warning role in patients at high risk of perioperative stroke. |
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