The Role Of Thromboelastography In The Evaluation Of Coagulation In Patients With Different Degrees Of Cirrhosis

ObjectiveBy monitoring blood clots elastic figure thromboelastography(TEG)to evaluate different degree cirrhosis of the liver function of blood coagulation,explore the TEG in judging the varying degree the role of risk of bleeding or thrombosis in patients with cirrhosis,in a timely manner to guide clinicians for effectively coagulopathy early treatment.Methods1.Collected the patients with liver cirrhosis diagnosed in the affiliated hospital of yan ’an university from 2016.11-2018.2,and excluded the tumor and the disease and drug use,etc;In addition,there were no primary or secondary tumors,no basic diseases affecting coagulation and drug use and normal liver function as the control group.To collect basic data and related clinical manifestations.2.All the research object to extract the peripheral venous blood test TEG、conventional coagulation index、 hepatic、 kidney function and exhibits enhanced CT + portal vein angiography、 abdominal ultrasound and gastroscope inspection,detection of liver changes、or have any degree of varicose veins and varicose.According to the clinical manifestation、results of gastroscope、 imaging results、 abdominal ultrasound results will be grouped patients,divided into hemorrhage and no bleeding、thrombosis and no thrombus group 、 with hemorrhage and thrombosis and hemorrhage unincorporated thrombus.All subjects were given Child-Pugh score of liver function,and were divided into three groups: Child A,B and C.3.SPSS20.0 statistical software was used to establish the database and analyze the data.The measured data in the normal distribution are expressed as mean ± standard deviation(±S).According to the Child-Pugh score、clinical manifestation、 imaging results、results of gastroscope grouping of multiple sets of data comparison between using variance analysis,t test was used to compare the data between the two groups with normal distribution.Do not conform to the normal distribution of measurement data to median ± four quartile spacing(M ± Q),According to the Child-Pugh score、 clinical manifestation、imaging results、results of gastroscope group does not conform to the normal distribution of measurement data for paired data Wilcoxon signed rank and inspection comparison.The data statistical analysis was statistically significant with P < 0.05.Results1.The study was selected in 122 cases,among which 37 females accounted for 30.33 percent of the total,while 85 males accounted for 69.67 percent,age range 26 ~ 87 years old,with an average age of 54.00 years.Another choice no cancer,no influence on the basis of coagulation disease and drug use,no liver function abnormal control group 28 cases,including 16 cases of male percentage accounted for 57.14%,female 12 percentage accounted for 42.86%,age range 28 ~ 62 years old,mean age,42.82 years.2.Compared with normal control group patients,the Child grading with different degree of TBIL in patients with cirrhosis liver function damage degree deepen significantly increased,and ALB、PLT,along with the Child A、B、C classification is falling,there were significant differences(P < 0.05).PT、APTT、INR values in the control group,and the Child A、B、C grade in extended gradually,there is a statistical difference(P < 0.05),D-D values in the Child A、B、C grade increased compared with control group,and the level of Fib decreased,which was statistically significant(P<0.05).The values of conventional coagulation index were the similar in the liver cirrhosis and normal control group,and have no statistical difference(P>0.05).Thrombus elastic figure detection,K、Angle、Ma、CI were in the Child A、 B、 C three groups and the control group both in the comparison between the two groups are xstatistically significant(P < 0.05),Compared with the control group,the R value increased and Angle angle decreased in the patients with cirrhosis,there were significant differences(P < 0.05).3.In liver cirrhosis Child – Pugh A、B、C bleeding and no bleeding in three group,PT、APTT significantly longer in patients with bleeding,Fib、PLT level drops,the patient is in a low coagulation state,which have statistical difference(P < 0.05);MA、 Angle and CI were all significantly reduced in child A、B and C indicating that the coagulation dysfunction of the patients was in a low coagulation state with statistical difference(P < 0.05).4.In liver cirrhosis Child – Pugh A、B、C level three in thrombosis and not thrombosis,D-D in Child A、B、C level three thrombus group increased significantly,the patient is in a state of high condensation,and have statistical difference(P < 0.05);The R value was shortened in the child C tertiary thrombus group,indicating that the patient was in a state of high condensation,there were statistical difference(P < 0.05).5.The Child C level in patients with cirrhosis of the liver hemorrhage combining thrombosis and hemorrhage was not the combining thrombosis,D-D in Child C group is higher than the unincorporated thrombosis in patients with bleeding merge thrombosis,the patient is in a state of high pour-point,have difference in statistically significant(P < 0.05);The Angle of angle was significantly lower than that of the combined thrombus group in the patients with Child c-grade hemorrhage,and there have a statistical difference(P < 0.05).Conclusion1.For patients with early cirrhosis,TEG was more sensitive than conventional coagulation indicators.2.TEG may reflect different degree of blood coagulation function in patients with cirrhosis of the liver disorder,this study,TEG patients with different degree of cirrhosis of the liver,the more severe liver function damage degree,its extending clotting time(R value),fibrinogen and platelet function gradually reduce(Angle angle and MA shorten,K value increases),indirectly reflects the cirrhosis of the liver disease severity.3.TEG in different levels in patients with cirrhosis of the liver bleeding,the patient is in a state of low condensate(Angle angle and MA value fell significantly shortened,CI),can predict risk of bleeding in patients with cirrhosis,in a timely manner to guide clinicians for effectively coagulopathy early treatment,especially the application of blood transfusion.4.TEG though at different levels in patients with cirrhosis and cirrhosis of the liver bleeding merge the thrombus,shorten the clotting time and fibrinogen overactive shorten,Angle angle increased value(R),but for the risk of thrombosis cannot be accurately forecast.