| Purpose:Using thrombo-elasticity chart,routine coagulation function,activated clotting time,and anti-Xa activity monitoring to detect coagulation status after IABP in patients with acute myocardial infarction,assess residual heparin after IAMP,and assess risk of bleeding and thrombosis to find more applicable coagulation status Detection method.Methods:The patients with acute myocardial infarction concurrent IABP implanted in Hunan Provincial People's Hospital from February 2017 to November 2017 were selected.General information was collected.Blood tests(nephelometric method)and coagulation function(immunoturbidimetry method)were used to detect Fbg,APTT,TT,and PT before surgery and on the 3rd day after surgery.Low molecular weight heparin was administered on the 3rd day after surgery(Low Molecular Weight Heparin(LMWH)Blood venous blood was drawn 4 h after subcutaneous injection.The thromboplasty was measured with citrate kaolin(CK-TEG)and heparinase(CKH-TEG);activated clotting time(ACT)was measured.The activity of anti-Xa was measured by chromogenic substrate method,and the difference of blood routine and coagulation function before and after surgery was compared.The correlation of coagulation function,PLT,TEG,ACT and anti-Xa activity was analyzed.The anti-factor Xa activity was low-fraction heparin.The ROC curve for the comprehensive evaluation of the diagnostic value of ?R and ACT was used as the concentration standard.The data obtained in this study were all statistically analyzed using SPSS 16.0 software.Results:1.56 patients were enrolled,and 6 patients were excluded because the IABP placement time was not more than 72 hours.A total of 50 patients met the inclusion criteria and were included in the group.The average time for IABP implantation in the enrolled patients was 5±2 days,and the age was 64.10± 14.33 years.(40 cases),hypertension(40 cases),diabetes(30 cases),hyperlipidemia(3 cases),smoking history(38 cases),previous myocardial infarction(5 cases),previous PCI(3 cases),Including the left anterior descending artery(25 cases),a stent(42 cases)was implanted and 2 stents(8 cases)were implanted.2.Preoperative and postoperative HGB,PLT results:Before and after the two groups,the mean was normal distribution,preoperatively was 130.85 ± 14.55g/L,230.39 ±22.72×109/L,postoperative HGB,PLT mean 105.17 ± 16.83g/L,148.42±17.75×109/L,there was a statistically significant difference between the two groups(P<0.05).At the same time,there was no significant difference in the parameters of coagulation after LMWH subcutaneous injection 4 hours before and on the 3rd day after operation(P>0.05).3.Postoperative CKH-TEG and CK-TEG results:44 patients were found to have ?R>1min by two groups of R-disparities,suggesting that residual heparin was effective,with an effective rate of 88.0%,and there was one case of R1>2 times R2.Excessive heparin,and 5 cases of ?R value showed no heparin residue,in which a small amount of hemoptysis R1 value 27.2min,?R hepatic excess,through the anti-factor Xa activity measured 1.021u/ml;4.The postoperative ACT results:The ACTs in all 49 cases were all greater than 150 normal healthy people's reference values(60.6-151s),1 case had ACT<150s in the reference range,and?R suggested>lmin;5.The results of postoperative anti-Xa factor activity:43 of them were between the effective anticoagulant concentrations 0.5-1.2u/ml,anti-Xa anticoagulant effective rate was 86.0%,7of them were<0.5u/ml,but anti-Xa activity still existed;6.Postoperative CK-TEG parameters and PLT correlations:R,CI and PLT were less correlated(r=0.123,0.213 P>0.05);MA and PLT were positively correlated,with high correlation(r=0.571 P<0.05);Angle was positively correlated with PLT,with high correlation(r=0.681 P<0.05);K was negatively correlated with PLT,with high correlation(r=-0.783 P<0.05);7.Use the anti-Xa factor activity as the standard of low-fractionated heparin,and use the ROC curve to evaluate the diagnostic value of ?R and ACT.The area under the ROC curve corresponding to the?R and ACT curves is 0.814 and 0.556(if the value is greater than 0.6,the criteria for achieving superior diagnostic value,except for very few intervals(sensitivity 0.00-0.05,specificity 0.95-1.00 range).The diagnosis of?R is inferior to ACT,and most of the remaining intervals ?R have excellent diagnostic results.In ACT,the difference was statistically significant(P<0.05);8.Correlation of ?R with ACT and anti-Xa activity after operation:?R was positively correlated with the activity of anti-Xa factor,and the correlation was high(r=0.421 P<0.05);the correlation between ACT and anti-Xa factor was low(r=0.214 P>0.05);9.0n the 3rd day after operation,the parameters of CK-TEG and CKH-TEG were different.There was a significant difference in the R and angle values between the two groups(P<0.05).There was no significant difference in other parameters(P>0.05).Conclusions:1.The use of CKH-TEG after IABP is superior-to the routine coagulation function coagulation status assessment and has certain clinical significance2.IABP postoperative monitoring of CKH-TEG compared with ACT better assessment of low molecular weight heparin residues,clinical heparin anticoagulant drugs to guide the use of significance. |
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