The Application Of Rapid Thrombelastography On Patients With Severe Trauma During Perioperative Period

Objective: Discussion on the relationship between the regulations of the dynamic change of Rapid Thrombelastography and the conventional coagulation indexes of patients with severe trauma,analyse its application value in the process of treatment of patients with severe trauma.Methods: From January 2015 to June 2016,60 patients with severe trauma who have been needed emergency surgery were selected in our hospital as the research object,respectively extract venous blood 6 ml at the following time :preoperative T1 and intraoperative(2 hours)after anesthesia T2,after the surgery T3,postoperative day 1(T4),postoperative day 3(T5),postoperative day 7(T6),which will be divided into three parts and then kept in constitutive rafter acid sodium blood coagulation test pipe(2 parts)and EDTAKz anticoagulation,the conventional coagulation function was respectively detected,which will be included as follows(APTT-activated clotting time live enzymes,PT,TT-thrombin time,prothrombin time,fibrinogen FIB-,D-D D-dimer),blood routine indexes(PLT-platelets)and fast thrombus elastic figure index(ACT-activated whole blood clotting time,MA-Maximum amplitude,K-clotting,α-angle coagulation formation rate,formation time LY30-fibrinolytic index),statistically analysis the relativity between the rapid blood clots elastic index,conventional coagulation function index and blood platelet.Results:1 The regularity changing of coagulation function at different time is as follows:(1)There are 52 cases which are APTT prolonged at T1 time among 60 cases accounted for 86.7%,Compared T1,T2,T3,T4,T5,T6,all points are all further prolonged(P<0.05);(2)At T1 time,there are 55 cases which are PT prolonged accounted for 91.7%,compared with the T1 time,PT value at T2,T3,T4,T5,T6 at all time points which are further extended,there were significant differences(P<0.05);(3)There are 48 cases whose FIB is decreased at T1 time accounted for 80%,compared the value at T1,among T2,T3,T4,T5,T6,FIB at each point are further increased,with statistical difference(P<0.05);(4)At T1 point,there are 50 cases with D-D significantly higher,accounted for 83.3%,compared with the value at T1 point,they all have been further increased than the value at T2,T3,T4,T5,T6,(P<0.05).2 The regularity changing of all indicators of thrombelastography at different time is as follows:(1)There are 55 cases whose ACT significantly prolonged in 60 cases,accounted for 91.7%,and when compared with the value at T1,there are further increase(P<0.05)at T2,T3,T4,T5,T6,all point.(2)There are 40 cases accounted for 66.7% whose K value were significantly prolonged at T1 point,and when compared with the value at T1,there are further increase(P<0.05)at T2,T3,T4,and when compared at T1,T5,T6 decreased significantly(P<0.05).(3)There are 41 cases accounted for 68.3% whose a value were significantly prolonged at T1 point,and when compared with the value at T1,there are further increase(P<0.05)at T2,T3,T4,T5,T 6 all points.(4)There are 48 cases accounted for 80.0% whose MA value were significantly decreased at T1 point,and when compared with the value at T1,there are further increase(P<0.05)at T4,T5,T 6 all points.(5)There are 38 cases accounted for 63.3% whose LY30 value at T1 time significantly higher,compared with T1,compare with every other point,the LY30 values were significantly reduced(P<0.05).3 The regularity changing of all indicators of blood platelet count at different time is as follows: There are 40 cases with a significant reduction accounted for 66.7% compared at T1 point,when it is at T2,T3,the blood planet count decreased significantly(P<0.05)compared with T1 at T4,T5,T6 each point,the blood platelet count significantly increased(P<0.05).4 The correlation analysis between the indicators of conventional coagulation and all indicators of thrombelastography(1)There is close positive correlation(P<0.05)between the ACT,APTT and FIB,there is negative correlation(P>0.05)between ACT,PT and D-D.(2)here is close positive correlation(P<0.05)between K value and,APTT,FIB,there is negative correlation(P>0.05)between K,PT and D-D.(3)There is close positive correlation(P<0.05)between a,APTT and FIB,there is negative correlation(P>0.05)between α,PT and D-D.(4)There is close positive correlation(P<0.05)between the MA,APTT and FIB,there is negative correlation(P>0.05)between MA,PT and D-D.(5)there is negative correlation(P>0.05)between LY30 and APTT,PT,FIB,D-D and the other indicators.5 The correlation analysis between all the indicators of blood platelet count before operation and Rapid thrombelastography such as a ACT,K,a,MA and so on and PLT(P<0.05),there is non correlated between thrombelastography indexes and PLT(P>0.05).Conclusion: The important indexes of Rapid thrombelastography are all have the connections with conventional coagulation and blood platelet indicators.This thrombelastography has some referenced function on the treatment of patients who are severely injured,which can be used for clinical guidance.