The Monitoring Value Of Thrombelastograph In The Patients Diagnosing Of Acute Cerebral Infarction Who Are Treated With Intravenous Thrombolysis

Background:Acute cerebral infarction is a common form of ischemic cerebrovascular disease. Inrecent years, with the aging of the population, the incidence increases gradually, andbecoming the first cause of death and long-term disability, which caused serious damageto the human health. The main pathological changes of the disease is atherosclerosis,lipid section fall off,vascular endothelial injury leads to platelet activation and activatethe body blood coagulation chain reaction, eventually leading to intracranial arteryblockages. Thus a variety of reasons lead to the imbalance in the body blood coagulationand fibrinolytic system, thrombosis is the main cause of the disease. At present,intravenous thrombolysis treatment of ACI is included in the guide line. However, howto warn of secondary cerebral hemorrhage earlier is still a hot and important subject inmodern medical research. If we can make early monitoring, assessment of coagulationand thrombus formation, systematic evaluation of therapeutic effect and prognosis forpatients, it will help doctors to make appropriate decisions to provide theoreticalguidance, so as to provide a positive effect on the prognosis of patients with treatment.Objective:Evaluating thrombelastograph (TEG) application value in the patients who arediagnosing of acute cerebral infarction and treated with intravenous thrombolysis,provides a new way of monitoring for decision-making and prognosis in clinicalintravenous thrombolytic treatment. Methods:Selecting105cases of cerebral infarction patients using rt-PA intravenousthrombolysis treatment as rt-PA group. According to the seven days’ modified Rankinscale, further divided into two sub groups which are good prognosis group (mRS is0—1)and poor prognosis group (mRS is2—5). Taking TEG tests before and2hours after thetreatment. At the same time, selection36healthy people in our hospital as control group.Taking TEG tests for them too. Recording coagulation reaction time (reaction time, R),hemagglutinate block forming time (kinetics of clot development, K), hemagglutinateblock formation rate (α angle), maximum intensity of blood clots (MA),coagulationindex(CI) five groups of data, to compare the data among the three groups, analyze thedata. Measurement data of normal distribution were indicated with mean±standarddeviation, analysis of variance or student t tests were performed on the norm variablies.TEG parameters determination method: collecting fasting venous blood in cerebralinfarction group and control group, with a tendency for0.109/L sodium citrate andanti-coagulation, instantly. Instrument in U.S. Haemoscope Cor company produces theThrombelastograph Analyzer TEG-5000blood clots elastic graph instrument,supporting the use of imported reagent Kaolin promoter reagent (Kaolin); Bloodsamples were using TEG-5000automatic trace detection TEG parameters.Results:105cases before rt-PA treatment compared with control group. The R value were4.47±0.89and6.47±0.67，α angle were63.18±10.61and58.21±4.05，CI value were1.73±1.33and0.0028±1.72。Compared with the control group, the R value decreased, αangle and CI value increased，differences were statistically significant（P <0.001）。Kvalue were2.36±1.51and2.22±0.43， MA value were58.75±9.20and58.79±4.01，which have no significant difference（P>0.05)。105cases after rt-PA treatment compared with control group. The CI value were-0.71±1.89and0.0028±1.72，K value were3.23±2.29and2.22±0.43, differences werestatistically significan（tP <0.05）。. The R value were5.89±2.30and6.47±0.67，α angle were56.44±10.31and58.21±4.05, MA value were58.40±7.40and58.79±4.01，whichhave no significant difference（P>0.05)。105cases of group A before and after the treatment whose R value were4.47±0.89and5.89±2.30respectively, K value were2.36±1.51and3.23±2.29respectively, α anglewere63.18±10.61and56.44±10.31, CI value were1.73±1.33and-0.71±1.89. Twohours after thrombolysis treatment, R and K value were increased obviously, α angle,and CI value were significantly reduced, differences were statistically significant (P <0.001). MA value before and after the treatment were58.75±9.20and58.40±7.40whichhave no significant difference (P>0.05).In the rt-PA with good prognosis, R value before and2hours after the treatmentwere4.35±0.73and6.09±2.07，K value were1.81±0.49and3.02±1.95，α angle were66.06±6.18and57.33±8.12，MA value were65.24±4.72and57.43±6.68，CI value were1.46±1.44and-0.46±1.81. After the treatment, R and K value were increased obviously.α angle, MAvalue and CI value were significantly reduced, differences were statisticallysignificant (P <0.001).In the rt-PA with poor prognosis, R value before and2hours after the treatmentwere4.58±1.02and5.70±2.51，K value were2.90±1.93and3.43±2.59，α angle were60.35±13.09and55.56±12.09，MA value were52.38±8.00and59.35±7.99，CI valuewere2.00±1.17and-0.95±1.95. After the treatment, R value, K value and MA valuewere increased obviously. α angle, MA value and CI value were significantly reduced,differences were statistically significant (P <0.001).In the rt-PA group before the treatment, the good prognosis compared with poorprognosis. R value were4.35±0.73and4.58±1.02which have no significant difference(P>0.05). The K value were1.81±0.49and2.90±1.93, α angle were66.06±6.18and60.35±13.09, MA value were65.24±4.72and52.38±8.00, CI value were1.46±1.44and2.00±1.17. The differences were statistically significant (P <0.001).In the rt-PA group after the treatment, the good prognosis compared with poorprognosis. R value were6.09±2.07and5.70±2.51, K value were3.02±1.95and3.43±2.59, α angle were57.33±8.12and55.56±12.09, MA value were57.43±6.68and59.35±7.99, CI value were-0.46±1.81and-0.95±1.95. The differences had no significant difference (P>0.05).The comparison of TEG data between people who had good prognosis and poorprognosis, ΔR were-1.73±1.93and-1.11±2.35, ΔMA were7.81±6.21and6.97±2.31,having no significant difference (P>0.05), ΔK were-1.21±1.79and-0.53±0.77, Δα anglewere8.73±6.30and4.79±2.18, ΔCI values were1.92±1.71and2.95±2.37. People whohad good prognosis, the numerical change of K value and α angle were more obvious,the change of CI value was small, the difference was statistically significant (P <0.001).Conclusions:TEG examination can be timely and accurate evaluate the blood coagulation statein patients with acute cerebral infarction. The group of taking thrombolytic therapycompared with the control group, R value, CI value, α angle changes in varying degrees.After the treatment with intravenous thrombolysis, the blood hypercoagulable state havevarying degrees of improvement. The comparison between good and poor prognosisgroup, before rt-PA treatment, the K value, α Angle and MA of good prognosis groupshowed high coagulation state obviously, the TEG index after thrombolysis had noobvious difference. The patients who had good prognosis had more significantlychanges of K value and α angle. The result reflects that TEG test can monitor thechanges of blood coagulation in patients diagnosing of cerebral infarction, which can beused as one of effective evaluation index for the therapy and prognosis of thrombolysistreatment.