| 1. Objective:Spine surgery patients suffer from large blood loss. With the influence of fluid resuisitation and hypothermia, the coagulation function change during spine surgery is significant and complicated. Whether to transfuse blood products, especially fresh frozen plasma (FFP), during surgery to correct the coagulation function is often determined by doctors according to clinical experiences and uncontrolled bleeding in the operating field. On the other hand, spine surgery patients have potential risks of developing deep vein thrombosis and pulmonary embolism due to postoperative immbolization. And there is not a universal guideline directing the use of anticoagulant drugs in spine surgery. Rapid-Thrombelastography (r-TEG) is a convenient point-of-care coagulation test device, which could provide comprehensive information on coagulation system. The aim of this study is to use r-TEG to investigate the coagulation function change during spine surgery, the effect of FFP of correcting it, and the postoperative coagulation function change of spine surgery patients.2. Method:Patients of the Department of orthopedics of PUMC receiving selective posterior scoliosis surgery and lumbar decompression surgery were enrolled from 2014 Dec to 2015 Apr. The exculsion criteria are as follows:age<14, BMI<18.5, ASA>III, PT prolong>3s, APTT prolong>10s, PLT<100*109/L or >400*109/L, Scr>120 mmol/L, AST or ALT>50 U/L, having received antifibrinolytics or NSAIDs 14 days before surgery, having received contraceptives 1 month before surgery and refusing the study. R-TEG, conventional coagulation test (CCT) and whole blood cell analysis were tested in every patient before and after surgery, before and after FFP transfusion, POD1, POD3 and before discharge. Other data include baseline values, blood product usage, blood loss, postoperative drainage volume, anticoagulant drug usage and complications, etc. All data were analyzed with SPSS 22.0.3. Result:1) 197 patients were enrolled in the study (scoliosis group 80, lumbar group 109). The age and body mass index were different in the two groups with siginificant differences.2) The impact of blood loss volume on r-TEG and CCT results of spine surgery patients:Patients losing less than 20% of the blood have a significantly decreased MA after the surgery. And all CCT parameters except INR and PLT also changed significantly. Patients losing 20-30% of the blood, their K, a and MA changed significantly after surgery with all of the CCT parameters changed significantly. Patients losing more than 30% of the blood, all of the r-TEG and CCT parameters changed significantly after the surgery.3) The effect of FFP on r-TEG and CCT results of spine surgery patients:Patients losing less than 30% of the blood, none of the r-TEG parameters improved, while patients losing more than 30% of the blood witnessed significantly-improved ACT, R, PT and APTT after FFP transfusion. 4) Postoperative r-TEG and CCT result change of the spine surgery patients:The parameters of r-TEG before operation were chosen as baseline value. For patients not receiving anticoagulant drugs in lumbar group, longer K time, smaller α angle and MA were observed on POD1; significant change in the K, α-angle, MA was observed after POD3 and discharge after operation, which is consistent with the results of CCT. The postoperative coagulation function change of lumbar patients receiving anticoagulants was the same with those not receiving anticoagulants in lumbar group. And the patients in scoliosis group not receiving anticoagulants had significantly longer ACT and R on POD1, and significantly shorter ACT and R after POD3, with other parameters almost the same with patients in lumbar group.5) Dividing patients not receiving anticoagulant drugs in lumbar group into different groups according to age>65 or ≤65, different sex, smoking history and BMI>28 or BMI≤28, their postoperative change of r-TEG and CCT parameters were not significantly different.4. Conclusion:1) For spine surgery patients with small to medium blood loss, only fibrinogen and platelet are deficient, clotting factors will not change significantly until massive bleeding.2) FFP can only improve the coagulation function of spine surgery patients with large blood loss, and the patients with small to medium blood loss should be give fibrinogen and platelet.3) Spine surgery patients undergo hypercoagulable state from POD3, and have fibrinogen and platelet hyperfunction, indicating a need of anticoagulation drugs from POD3.4) Patients receiving anticoagulation drugs also have hyperfunction of fibrinogen and platelet, indicating a need of antiplatelet drugs.5) There is no significant impact of age, sex, BMI, smoking history on the postoperative coagulation function change of spine surgery patients. |
PDF Full Text Request