| Objective Monitoring of coagulation function in patients undergoing cardiac valve replacement by thromboelastogram(TEG)and analysing the influence of blocking time,heparin action time,cardiopulmonary bypass(CPB)time,age,vitamin K1 acting time,number of valve replacement,body mass index(BMI)and hematocrit before and after CPB on coagulation factor and fibrinogen of patients undergoing surgery to provide reference for the clinical control of non-external bleeding after cardiac operation and improve the guidance of TEG on blood transfusion after operation,reduce the incidence of secondary surgery and improve the safety of heart valve replacement operation.Methods Fifty-five patients with cardiac valve replacement surgery were randomly selected from January 2018 to December 2018 in the Department of cardiac surgery of the first People’s Hospital of Yichang,as the research object.In the experiment,4 patients with abnormal results of TEG were excluded.The 3-group abnormal data was excluded after the data of the remaining 51 patients were detected by the box-line chart.The data of the remaining 48 patients were further studied.All the patients were non-pregnant or lactation adults.All patients signed the relevant informed consent form.The operation was performed by the chief physician under endotracheal intubation,general intravenous inhalation anesthesia and CPB.All patients were examined by heparinase cup and blood gas analysis after deep venous catheterization and before 5min was infused with protamine.According to the participation of extracorporeal circulation,they were divided into two groups(group I took blood after deep vein catheterization,and group II took blood before infusing protamine).The parameters of TEG in two groups were recorded respectively.R is the time that the blood is placed in the TEG analyzer to the beginning of fibrin formation,and the normal range is 2 to 8 minutes.K is the time of clot formation from the end of R time to the amplitude of 20 mm,and the normal range is 1 to 3 min.Angle is from the point of blood clot formation to the maximum curve radians of the drawing as the angle between the tangent and the horizontal line,and the normal range is 55 to 78°.We analyze the row correlation and multivariate linear regression of the collected data to analyze effects of BMI,age,heparin action time,blocking time,CPB time,number of valve replacement,days of Vit K1 use before operation and hematocrit before and after CPB on coagulation factor and fibrinogen in patients.Results(1)The correlation and linear regression analysis of the indexes of TEG before CPB.(1)R is negatively correlated with vitamin K1 acting time,preoperative hematocrit,BMI and age,among which hematocrit is the most important factor.(2)K is negatively correlated with preoperative hematocrit and age,among which hematocrit is the most important factor.(3)Angle is positively correlated with age only.(2)The correlation and linear regression analysis of the indexes of TEG after CPB.(1)R is positively correlated with blocking time,heparin action time and number of valve replacement,among which blocking time is the most important factor.(2)K is positively correlated with number of valve replacement and CPB time,among which number of valve replacement is the most important factor.(3)Angle is negatively correlated with CPB time only.(3)The correlation and linear regression analysis of range of change of the indexes of TEG before and after CPB.(1)The range of change of R is positively correlated with vitamin K1 acting time and BMI,among which vitamin K1 acting time is the most important factor.(2)The range of change of K is positively correlated with vitamin K1 acting time and BMI,among which vitamin K1 acting time is the most important factor.(3)The range of change of Angle is positively correlated with vitamin K1 acting time,BMI and age,among which BMI is the most important factor.(4)The correlation analysis of the related factors to the indexes of TEG.(1)There was a significant correlation between the number of valve replacement and R before CPB,R after CPB and K after CPB,and a higher correlation was found between the number of valve replacement and R after CPB.(2)There was a significant correlation between vitamin K1 acting time and R before CPB,The range of change of R before and after CPB,The range of change of K before and after CPB and The range of change of Angle before and after CPB,and a higher correlation was found between the vitamin K1 acting time and the range of change of R before and after CPB.(3)There was a significant correlation between hematocrit before CPB and R before CPB and K before CPB,and a higher correlation was found between hematocrit before CPB and the R before CPB.(4)There was a significant correlation between the BMI and R before CPB,The range of change of R before and after CPB,The range of change of K before and after CPB and The range of change of Angle before and after CPB,and a higher correlation was found between the BMI and The range of change of Angle before and after CPB.(5)There was a significant correlation between Age and R before CPB,K before CPB,Angle before CPB and The range of change of Angle before and after CPB,and a higher correlation was found between Age and Angle before CPB.(6)The blocking time was only significantly correlated with the R value after CPB.(7)The heparin action time was only significantly correlated with the R value after CPB.(8)There was a significant correlation between CPB time and K after CPB and Angle after CPB,and a higher correlation was found between CPB time and K after CPB.Conclusions(1)The effects of CPB factors(number of valve replacement,blocking time,heparin action time and CPB time)on coagulation factor and fibrinogen in patients with heart valve replacement were significantly higher than those of their own factors(age,BMI,hematocrit)and preoperative intervention factors(vitamin K1 action time).And CPB factors can greatly weaken the degree of influence of the self-factors and preoperative human intervention factors.In general,the effect of CPB on coagulation factor and fibrinogen in patients undergoing heart valve replacement is acceptable.(2)Vitamin K1 can only improve the coagulation function before CPB,but has no obvious effect on the protection of coagulation substance,and may even aggravate the consumption of coagulation substance during CPB operation. |
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