The Correlation And Clinical Value Of Thromboelastogram Index And Postoperative Infection And Bleeding In Patients With Percutaneous Nephrolithotomy

Objective: To analyze the correlation between thromboelastogram indicators and postoperative infection and bleeding in patients undergoing percutaneous nephrolithotomy,and provide experimental evidence for clinical treatment and prevention.Methods: The clinical data of 90 patients with percutaneous nephrolithotomy were selected for a retrospective study.The study period was from December2019 to December 2020.According to the presence or absence of infection,they were divided into non-infected group(n=63)and infected group(n=27);according to the presence or absence of bleeding,they were divided into non-bleeding group(n=71)and bleeding group(n=19).(1)Compare the clinical data of the infected group and the non-infected group,the bleeding group and the non-bleeding group,including gender,age,operation time,glomerular filtration rate(GFR),stone length,stone width,stone CT value,white blood cell Count(WBC),Hemoglobin(Hb),Platelet Count(PLT),Centrogranulocyte Proportion,Prothrombin Time(PT),International Normalized Ratio(INR),Activated Partial Thromboplastin Time(APTT),D2 polymer,Procalcitonin(PCT),Interleukin-6(L-6),and coagulation reaction time(R value),coagulation time(K value),maximum clot strength(MA),coagulation angle(Angle).(2)To analyze the risk factors of postoperative infection and postoperative bleeding in patients undergoing percutaneous nephrolithotomy.(3)Analyze the correlation between GFR and bleeding and infection,as well as the correlation between thromboelastography indicators and postoperative infection and postoperative bleeding in patients with percutaneous nephrolithotomy.(4)Analyze the K value,MA value,ANGLE angle,R value,and ROC curve of the combined index.Results: Comparison of general information such as gender,age,operation time,GFR,stone length,stone width,stone CT value,INR,APTT,R value,K value,MA value,ANGLE angle between the infected group and the non-infected group,there was no statistical difference Significance(all P>0.05).The general data of the infected group and the non-infected group,such as WBC,Hb,PLT,neutrophil ratio,PT,D2-mer,and PCT,are different(all P<0.05);the infection group WBC(12.94±5.13>10.80±3.53)×109/ L.Neutrophil ratio(0.87±0.06>0.81±0.09),D2 polymer(2.82±0.77>1.30±0.65)ug/ml,PCT(2.49±0.17 > 0.07±0.03)ng/ml,IL-6(36.37±3.05>16.45±1.32)ng/ml was higher than the non-infected group(P<0.05);Hb(122.46±26.08<132.76±16.46)g/L,PLT(166.07±40.27<197.73±68.88)in the infected were lower than those of the non-infected group(all P<0.05).The binary logistic regression analysis showed that increased WBC,decreased Hb,decreased PLT,and increased proportion of neutrophils were influencing factors for predicting postoperative infection in patients undergoing percutaneous nephrolithotomy(P<0.05).There was no statistically significant difference between the general information of the bleeding group and the non-bleeding group,such as gender,age,operation time,stone length,stone width,WBC,PLT,centripetal cell ratio,PT,INR,APTT,and R values(P both >0.05).The general data of bleeding group and non-bleeding group such as GFR,CT value of stones,Hb,D2 polymer,PCT,IL-6,K value,MA value,angle angle are different(P<0.05);bleeding group GFR(35.98±10.15 < 44.39±12.96)%,Hb(101.26±14.36 <137.13±14.12)g/L,D2 polymer(1.63±0.11 < 1.81±0.05)ug/ml,K value(1.67±0.45 < 2.23±0.93)lower than non-bleeding group(all P < 0.05);hemorrhage group’s stone CT value(1110.84±239.25>965.86±230.97),PCT(1.03)±0.17>0.77±0.08)ng/ml,IL-6(49.47±5.45>15.17±3.25)ng/ml,MA value(63.27±5.31>60.23±2.23),ANGLE angle(67.25±4.75 >61.27±8.82)Higher than the non-bleeding group(P<0.05).The binary logistic regression analysis showed that the decrease of Hb,the decrease of K value,and the increase of ANGLE angle were independent factors in predicting postoperative bleeding in patients undergoing percutaneous nephrolithotomy(P<0.05).Correlation analysis shows that,GFR is not correlated with white blood cell count(r=-0.045,P>0.05);GFR is positively correlated with hemoglobin(r=0.335,P<0.05).Hb was positively correlated with K value and R value,and negatively correlated with MA value and ANGLE angle(r=0.508/0.391/-0.349/-0.548,both P<0.05);PLT was positively correlated with MA value and ANGLE angle Correlation(r=0.296/0.215,P<0.05);APTT is positively correlated with R value(r=0.224,P<0.05).ROC curve analysis showed that the area under the curve of K value AUC value(0.707,P<0.05),Youden index 0.416,sensitivity 89.50%,specificity 52.10%;the area under the curve AUC value of MA value(0.618,P>0.05),Youden index 0.303,sensitivity89.50%,specificity 40.80%;AUC value of area under the curve of ANGLE angle(0.720,P<0.05),Youden index 0.430,sensitivity 89.50%,specificity53.50%;R value The area under the curve AUC value(0.610,P>0.05),the Youden index 0.377,the sensitivity 84.20%,and the specificity 53.50%;the area under the curve AUC value of the combined index(0.696,P<0.05),Youden index 0.384,The sensitivity is 94.70% and the specificity is 43.70%.Conclusion: Thromboelastography indicators can be used to assess the coagulation function of patients undergoing percutaneous nephrolithotomy and predict the risk of postoperative bleeding.Postoperative infection is an important risk factor for postoperative bleeding.Clinical prevention and treatment should be done to reduce postoperative infection.And the incidence of bleeding is of great significance.