The Application Value Of Thrombelastography(TEG) In The Perioperative Period Of Cardiac Valve Replacement Under Cardiopulmonary Bypass

BackgroundSince cardiopulmonary bypass caused pathophysiological changes that leads to and aggravate the dysfunction of blood coagulation function to the internal environment and coagulating system,Cardiac valve replacement has resulted in abnormal bleeding and complications after operation.Clinically,doctors often apply conventional coagulation tests to evaluate the coagulation function of patients during perioperative period,not only because conventional coagulation tests show a certain stage of coagulation process rather than the whole picture of coagulation,but because it cannot judge the causes of abnormal coagulation sometimes.Thromboelastography(TEG) can quickly and accurately evaluate the coagulation function of patients,achieve a dynamic,complete,continuous and real whole blood test,and comprehensively analyze the functions of plasma components and cell components on blood coagulation during coagulation.ObjectiveThis paper aims to explore the application value of thromboelastogram(TEG) during perioperative period of cardiac valve replacement by analysing the effects of cardiopulmonary bypass on cardiac valve replacement and comparing different coagulation functions of thromboelastogram(TEG) and conventional coagulation tests during perioperative period of cardiac valve replacement.MethodScreening of 36 patients undergoing elective cardiac valve replacement were selected as subjects.Blood samples were collected from all patients preoperatively,Analysis of changes in the values of the results,entering intensive care unit and 24 h postoperatively for elastograms detection of thromboelastography,conventional coagulation test and routine blood tests.The R value(coagulation reaction time),K value(coagulation formation time),alpha Angle,MA(maximum amplitude)of TEG were correlated with prothrombin time(PT),activated partial coagulation time(APTT),international standard ratio(INR),hemoglobin and platelet(PLT) in blood routine.To analyze the monitoring significance of parameters of thrombuselastograms during cardiac valve replacementon the coagulation function of perioperative patients and guide clinical treatment.Result1?There is significant differences in hemoglobin,red blood cell and platelet count between perioperative patients with cardiac valve replacement(P<0.05).entering intensive care unit hemoglobin decreased compared with preoperative by19.6 % (P<0.05)?red blood cells decreased by 19.1% (P<0.05).<0.05),and platelets decreased by 31.3 % (P<0.05).Postoperative 24 h hemoglobin decreased compared with preoperative.by 24.3% (P<0.05),red blood cells decreased by 24.1% (P<0.05),and platelets decreased by 38.2% (P < 0.05).2?There is significant differences in TEG parameters between the perioperative patients with cardiac valve replacement(P<0.05),compared with preoperative,entering intensive care unit the R value increase by 25.7% (P<0.05)? K increase by60.9% (P<0.05).??-Angle decreased by 18.1% (P<0.05)and MA decreased by 16.6% (P<0.05);there is significant difference between R,K and MA after 24 h after operation compared with preoperative,The R value decreased by 13.0% (P<0.05);K increase by 18.6% (P<0.05);MA decreased by 10.3% (P<0.05).3?This study finds that there is a significant correlation between R value and K?MA&PLT entering intensive care unit the perioperative patients with cardiac valve replacement,a significant correlation between K value and APPT ?PLT??& MA(P<0.05),a significant correlation between MA(maximum amplitude)and APTT&PLT(platelet)(P<0.05).After doing cardiac valve replacement,the abnormalities of coagulation function lie in PLT's decrease,PT & APTT &INR's increase,R and K's increase and MA's decrease.Conclusions1?This paper makes it clear that there is a significant correlation between the parameter values of thromboelastography(TEG) and conventional coagulation test for patients who have undergoing cardiac valve replacement under cardiopulmonary bypass.2?Thromboelastography(TEG) plays an important role in monitoring the coagulation function of the patients,which can quickly and accurately evaluate thecoagulation function during perioperative period and guide an reasonable ?effective and safe of blood transfusion clinically.