The Changes Of Coagulation Function And Fbrinolytic System In Rheumatic Heart Disease Patients With Left Atrial Thrombus PERI-Cardiopulmonary Bypass

Objective:Observed two groups of rheumatic heart disease patients of blood coagulation changes in order to study the left atrial thrombosis whether would increase the impact of cardiopulmonary bypass on blood coagulation and fibrinolytic system in rheumatic heart disease patients.Methods:Regardless of gender, weight, age, in accordance with the random number table,30patients of rheumatic heart disease with left atrial thrombus (confirmed by the operator),who received cardiac vavle replacement undergoing cardiopulmonary bypass from Dec2010to Oct2011in the Cardiovascular Disease Institute of the First Affiliated Hospital of Guangxi Medical University, were selected randomly as the observation group (group E), and in the meantime, another30patients of rheumatic heart disease without left atrial thrombus were also selected as the control group (group C).Take four time points, T1:before skin incision, T2:10minutes after the protamine reversal of heparin, T3:the end of surgery, T4:4hours after surgery to observe the changes of Platelet count(PLT), Hemoglobin(Hb), Plasma free calcium ions(Ca2+), Activated clotting time(ACT), Prothrombin time(PT), Activated partial thromboplastin time(APTT), Thrombin time(TT), Fibrinogen(FIB), D-dimer(D-D) and other indicators of the two groups patients at each time point. The amount of banked blood of intraoperative and postoperative24hours, the amount of chest drainage postoperative24hours, the postoperative complications, etc, were also recorded at the same time.Results:(1)All patients had no postoperative low cardiac output, the second thoracotomy and incidence of death, all recovered.(2)The statistic was not significantly difference for the two groups of patients on the sex ration, age, weight, surgical approach, operation time, CPB time, aortic cross-clamping time, the amount of chest drainage24h after operation, the amount of the24h of allogeneic blood, etc,(P>0.05). The patients of group E had higher ration significantly of atrial fibrillation than the group C (p=0.000).(3)The differences of PLT, Hb, Ca2+, ACT, PT, APTT and TT between the two groups were not statistically significant (P>0.05). The patients in group E had higher FIB and D-D than those in group C at each time point (P<0.05). Compared with the time point T1, PLT, Hb, FIB and TT reduced significantly at time point T2, T3, T4(P<0.05). Compared with the time point T1, Ca2+was also reduced significantly at time point T3and T4(P<0.05). Compared with the time point T1,PT was prolonged significantly at time point T2, T3, T4(P<0.05) and APTT was prolonged at time point T2(P<0.05).Conclusion:The changes of blood coagulation and fibrinolytic system in rheumatic heart disease patients with left atrial thrombus peri-cardiopulmonary bypass were in accord with the changes of blood coagulation and fibrinolytic system in rheumatic heart disease patients without left atrial thrombus. But the rheumatic heart disease patients with left atrial thrombus had blood hypercoagulation and hyperfibrinolysis state. The coagulation system and fibribolytic system of the rheumatic heart disease patients with left atrial thrombus were still relatively higher than those of rheumatic heart disease patients without left atrial thrombus.