The Value Of Intraoperative R-TEG Monitoring On Patients’Coagulation Mechanisms And The Intervention

Objectives:As medical career is rapidly developing in China, the scarcity of blood products and their rational use become important problems worth paying close attention to. However, blood products used for correcting coagulational function are still used according to clinical doctors’ experience. As a result, it’s essential to find a method for testing patients’ coagulational function that is fast, accurate and comprehensive. Rapid thrombelastography is more comprehensive and rapid than conventional coagulation tests, and probably becomes an important reference for future transfusion of blood products related to coagulational function correction. Unfortunately, it’s not widely used in China, and the relationship between rapid thrombelastography indices and blood loss is still unclear. This research intends to analyze the relationship between rapid thrombelastography indices changes and blood loss in patients with normal coagulational function undergoing neurosurgery, and to compare rapid thrombelastography indices with conventional coagulation tests indices on their ability of reflecting the influence of intraoperative bleeding to coagulational function.Methods:We selected patients undergoing single transsphenoidal sellar lesion resection or resection of intracranial lesion through craniotomy in the department of neurosurgery, Peking Union Medical College Hospital. The inclusion criteria were age between15and65, ASA grade I or II, normal preoperative coagulational function, liver function and renal function, no history of using preoperative coagulation-related drugs, and agree to take part in the research. We recorded detailly the patients’ basic information, general circumstances, preoperative and postoperative coagulational function tests, whole blood cell analysis and rapid thrombelastography indices, intraoperative blood loss volume, and postoperative drainage in detail. Then cases were grouped as needed and IBM SPSS20was used for statistical analysis.Results:1. Among neurosurgery patients, sex, age and body mass index have impact on the rapid thrombelastography indices. Senior patients, women and fat patients presented with a hypercoagulable state, and the result is in great agreement with conventional coagulation tests.2. The coagulational function changes caused by intraoperative bleeding in neurosurgical patients are mostly related to fibrinogen and platelets loss. Only two indicators, K and a, are significantly associated with the amount of bleeding. The current empirical knowledge of the effect of bleeding on coagulational function is not accurate. The influence of bleeding on fibrigonen and platelets should get more attention.3. Rapid thrombelastography is able to help finding the specific reason that affect patient’s coagulation state and fastly correcting the coagulational abnormity.4. Prothrombin time, activated partial thromboplastin time, and international normalized ratio may help predict postoperative blood loss in patients.5. Neither preoperative rapid thrombelastography nor conventional coagulation tests are good indicators of intraoperative blood loss.Conclusion:Rapid thrombelastography can reflect the overall situation of coagulation rapidly, and some of its indices are strongly related to blood loss. So it can be an important alternative method for directing the transfusion of blood products.