Thromboelastography(TEG) Application In The Changes Of Coagulation Function In The Operation Period In Vitro Evaluation Of Cardiac Surgical Operation Cycle Around

Objective:By thromboelastography(TEG) for the evaluation of peri operation period of change of blood coagulation function in vitro circulation operation of cardiac surgery, identification of clinical extracorporeal circulation cardiac surgical operation during and after the operation, the bleeding causes, guiding the development of cardiac surgical operation in abnormal bleeding, postoperative treatment, improve the safety of cardiac surgical operation.Method:Screening of the Department of cardiac surgery of the Second Affiliated Hospital of Hebei Medical University in December to 2014 2013, quasi patients with heart surgical operation in 77 cases, as the research object. All patients under cardiopulmonary bypass(CPB) for non cyanosis non pulmonary hypertension of congenital heart disease in patients with valvular heart disease or operation, Among 41 patients with congenital heart disease group, 36 patients with valvular heart disease surgery, all the patients have been excluded from the primary diseases of blood system, severe renal insufficiency, ASA grade I ~ III, all patients were in normal tracheal intubation inhalation for operation anesthesia, intravenous heparin 3mg/kg, systemic heparinization turn indicator set for ACT > 480 s, before anesthesia and 15 min after protamine and heparin for venous blood TEG(Haemoscope 5000 Series) and ACT(Medtronic) determination, after protamin injection, blood samples were used containing heparin enzyme and without heparin enzyme assay cup test thrombelastography, micro suppository filter using imported membrane oxygenator and arterial extracorporeal circulation, the use of non pulsatile perfusion, crystal or blood cardioplegia perfusion and preservation of heart, after stopping heparin protamine Bai Zhonghe 1:1. Includes recording the TEG parameters: R(coagulation time, refers to the blood samples were first detected fibrin formation time required, the normal value of 4 ~ 8min), the value of K(coagulation time, coagulation is from start to TEG electrogram amplitude reached 20 mm of the time, the normal value of 1 ~ 4min), alpha-Angle(solidification angle, from the formation of the blood clot to tracing the maximum curve radian as tangent line and horizontal line angle, representative of blood clot formation rate, the normal value of 47 ~ 74 DEG), MA value(maximum amplitude, maximum amplitude, reflecting the blood clot absolute intensity, the normal value of 55 ~ 73 mm), LY30(30min MA determined after fibrinolysis rate, the normal value of 0 ~ 7.5%), CI(coagulation index, coagulation index, normal value of-3 ~ +3). CL30(measured in MA value to determine blood clots dissolve within 30 minutes after the rest of the percentage, is a reflection of the degree of fibrinolytic activity).Result:1 Compare the incidence of abnormal results in patients with congenital heart disease and valvular disease group, and took two groups of patients with TEG parameters, fibrinogen levels and platelet counts, the results showed that patients with congenital heart disease and valvular disease group TEG parameters is no significant difference, P > 0.05 is not statistically significant; Valvular disease patients preoperative TEG fibrinogen lack rate higher than that of congenital heart disease group, P < 0.05, statistically significant, intraoperative and postoperative early no statistical difference.Preoperative alpha Angle valve disease group is slightly lower than normal. Compared with preoperative, intraoperative and postoperative early two groups there are fewer Plt and Fib decrease(P < 0.05). Intraoperative and postoperative early Fib level valve disease group was lower than those of congenital heart disease group(P < 0.05), and other parameters of TEG no statistical difference.2 Compare two groups of patients with preoperative, intraoperative and postoperative incidence of abnormal distribution of TEG results. 2 cases of lack of clotting factor of valvular disease. 2 cases of enhanced platelet function, high condensation, including 1 case of valvular disease, another example. For congenital heart disease Intraoperative and postoperative abnormal reason often coexist in the same patients.Two groups of the preoperative and postoperative patients TEG results comparison shows that compared with preoperative, K value significantly extend postoperatively in patients with valvular disease group, two groups of patients with alpha Angle, MA and CI were significantly lower, P < 0.001). To eliminate the effects of residual heparin with heparin enzymes, can be part of shortening R and K, increased alpha value. Although postoperative K and alpha Angle compared with preoperative difference was statistically significant, but the average is still within the normal range, and MA has dropped to below the normal range, prompt postoperative platelet function significantly reduced, surgery before and after the comparison, while significantly reduce postoperative platelet counts, P < 0.001, but the mean is still within the normal range.Conclusion:TEG can provide postoperative coagulation fibrinolytic function of information more comprehensive, accurately reflect the blood coagulation function and blood coagulation in vivo functional imbalance of patients, is a practical, effective monitoring method. TEG monitoring in the operation plays an important role in the function of platelet, coagulation factors and guidance for safe, effective blood transfusion, to better predict the risk of bleeding during operation. If according to the results to the intervention measures, can reduce the risk of bleeding in operation, and reduce the operation amount of blood transfusion, effectively reduce the risk of transfusion to bring, and can guide clinicians to high bleeding risk in patients with timely treatment.