Application Of Thromboelastography In The Detection Of Coagulation Function In Patients Undergoing Extracentric Surgery And Patients With Liver Disease

Research backgroundThe coagulation function is the ability to change the blood from a flowing state to a non-mobile gel state.The essence is the function of converting soluble fibrinogen into insoluble fibrinogen in plasma.In a narrow sense,it refers to the function of coagulation factors activated in sequence to produce thrombin when blood vessels are damaged.The ability to turn fibrinogen into fibrinogen and promote blood coagulation.In a broad sense,coagulation also includes platelet activity.Clinical factors such as trauma,inflammatory reaction,coagulation factor consumption,fibrinolysis abnormality,hemodilution,anticoagulant use,hypothermia,and so on often affect the patient's coagulation function and lead to bleeding that is difficult to control clinically.Thrombosis and secondary organ dysfunction seriously affect the diagnosis,treatment and prognosis of patients.The high expression of plasma inflammatory factors was consistent with the changes of coagulation function.The plasma inflammatory factors IL-6 and IL-1 ? were increased by surgical stimulation.Inflammatory factors affect coagulation and fibrinolysis through different mechanisms.Neural tissue itself has a certain effect on local coagulation and fibrinolysis,such as normal brain tissue and astrocytoma cells will express a large number of tissue factor TFs start.Coagulation.Plasma tissue factor inhibitory factor increased in patients with glioblastoma and brain metastases,which may lead to mild disseminated coagulation dysfunction.Brain tumors affect coagulation and fibrinolysis,leading to a higher incidence of deep venous thrombosis and pulmonary embolism in neurosurgical patients.The liver is the largest metabolic organ in the human body.When the liver changes,the synthesis of these coagulants,especially vitamin K dependent coagulation factors and fibrinogen,decreases,clears the dysfunction,and reduces the synthesis of antithrombin ? and plasminogen.DIC and primary hyperfibrinolysis may occur in severe liver diseases and liver failure,and portal hypertension,hyperemia and thrombocytopenia may lead to abnormal coagulation function,and even increase the risk of bleeding or thrombosis.In recent years,thromboelasticity has been gradually used in obstetrics and urology,as one of the tools for clinical diagnosis and treatment.At present,thromboelastography has been widely used,such as:clinical liver transplantation,cardiovascular surgery,kidney transplantation,tumor.Blood transfusion therapy,etc.,but at present,thromboelastography has not been discussed in detail to detect the coagulation function of patients undergoing extracorporeal surgery and liver disease,and to reflect the specific changes in the state of coagulation.Therefore,thromboelastography is mainly used to detect the coagulation function of patients undergoing extracorporeal surgery and liver disease,and to explore the significance of its change,thus providing useful information and basis for clinical diagnosis of coagulation status of patients.Part 1 The application of thromboelastic diagram in the measurement of blood coagulation in patients undergoing extra-operative surgeryObjective To investigate the Thrombelastogram(TEG)on the significance of monitoring the change of coagulation function before and after surgery patients in the Department of Neurosurgery,and analysis the correlation between the Thrombelastogram and traditional coagulation function.Method A total of 100 cases of patients in the Department of Neurosurgery were collected,then compare the change before and after the operation of the indexes of TEG,To explore the relationship between TEG detection index and traditional coagulation indexes.Result Before and after the operation of MA value were statistically significant,differences are statistically significnt(P=0.005),Department of Neurosurgery surgery has a certain effect on the platelet function of patients.R was positively correlated with APTT(r=0.271,p=0.006),K is negatively correlated with Fg(r=-0.446,p=0.000),and negative correlation with PLT(r=-0.417,p=0.000),aangle is positively correlated with Fg(r=0.423,p=0.000),and negative correlation with APTT(r=0.211,p=0.035),positive correlation with PLT(r=0.375,p=0.000),MA was positively correlated with PLT(r=0.555,p=0.000),positively correlated with Fg(r=609,p=0.000).Conclusion TEG detection can response the changes in platelet function before and after the reaction of patients in the Department of Neurosurgery surgery,and there is a certain correlation between the test indexes of TEG parameters with the traditional coagulation function,at the same time with the traditional detection of coagulation function test,can play a complementary role.Part 2 The application of thromboelastography in detecting coagulation function in patients with liver diseaseObjective This study focused on analyzing the changes of blood coagulation function in patients with liver diseases,exploring the significance of TEG in the detection of coagulation function in patients with liver diseases,then to further guide the clinical diagnosis and treatment for patients with liver disease.Method A total of 54 patients whith liver disease in Aguest 2017-September 2017 treated in our hosptal were enrolled in this study.which is as observation group,54 healthy subjects as control group.Two groups were all detected by Thrombelastogram instrument,and compare the difference of TEG index between this two groups.Detect the tranditional coagulation function of the observation group,to explore the significance of changes.To explore the relationship between TEG detection index and traditional coagulation indexes.Result Detection of thrombelastogram,compared with the control group,the R value of the observation group decreased,differences are statistically significnt(P<0.01);the MA value decreased,differences are statistically significnt(P<0.01).Thedifferences of K value?a value?LY30 and EPL are no statistically significnt(P>0.05).The different diseases of the patients with liver disease were compared with those of the control group,hypohepatia group R value decrease,differences are statistically significnt(P<0.01),the differences of K value?? value?MA value?LY30 and EPL are no statistically significnt(P>0.05);hepatitis B group and cirrhosis group R and MA value decreased,differences are statistically significnt(P<0.01),the differences of K value.? value?LY30 and EPL are no statistically significnt(P>0.05);liver failure group MA value decreased,differences are statistically significnt(P<0.01),the differences of K value?a value?LY30 and EPL are no statistically significnt(P>0.05).Detection of traditional coagulation function,the patients in the observation group were PT,APTT,TT extended,differences are statistically significnt(P<0.01);Fg,antithrombin?decreased,differences are statistically significnt(P<0.01),factor? activity increased,differences are statistically significnt(P<0.01).In the correlation analysis,there was a positive correlation between APTT and R,a negative correlation between PLT and K,a positive correlation with ?,a positive correlation between APTT and R,a positive correlation between APTT and R,a positive correlation between APTT and R,a positive correlation between APTT and R,a positive correlation between APTT and R,a positive correlation between APTT and K,a positive correlation between PLT and K,and a positive correlation between PLT and K,and a positive correlation between PLT and a.Conclusion TEG detect the changes of blood coagulation function in patients with liver disease,which is complementary to the traditional coagulation function test,and which is of great significance to guide the clinical diagnosis and treatment for patients with liver disease.There was a certain correlation between the parameters of TEG and the indexes of tranditional coagulation test.