| Objective To analyse the characteristics in different liver diseases patients byobserving the Routine coagulation tests and thrombelastogram(TEG) and compare thedifference between the two methods. Understand the influence on coagulation status byplasma exchange through observing the changes of coagulation function tests and TEG.Explore the influence on the TEG from anti-coagulant by obseving the changes ofroutine coagulation tests and TEG between before CBP (continuous blood purification)treatment, after CBP treatment6hours and after CBP treatment12hours, comparing theinfluence to the coagulation status by no anti-coagulant and a small dose low molecularweight heparin. The optimized anti-coagulant dosage is discussed initially.Methods59cases of hepatic failure patients were the subjects and59cases ofacute or chronic hepatitis,54cases of compensatory liver cirrhosis,52cases ofdecompensated liver cirrhosis at the same period were served as the controls. Peripheralbloods were taken and tested with blood routine tests, routine coagulation tests and TEGwere measured and compared between different groups.28patients were treated byplasma exchange and the conventional coagulation and TEG variables were comparedbetween before and after the treatment. To the67times CBP, blood routine andconventional coagulation tests and TEG were detected. The variables were comparedbetween before CBP treatment, after CBP treatment at6hours and12hours.Results PTA, INR, FIB in hepatic failure patients were worse than those in patiensof acute or chronic hepatitis, compensatory and decompensated cirrhosis(all P <0.05). R value (10.29), K value (4.90), α-angle (41.32) and CI (-7) in liver failurepatients were no different from those in decompensated liver cirrhosis (7.8,4,44.05，-5.95, respectively), and were different significantly from those in compensatory livercirrhosis (6.75，3.41,52.77,-2.6, P＜0.05) and acute or chronic hepatiti（s6.6,2.1,63.2,-0.9, P＜0.05）. The white blood cells, red cells and platelets in peripheral blood werenot significantly changed after plasma exchange (P>0.05) and prothrombin activity(PTA), the international standardization ratio (INR), fibrinogen were significantlyimproved than those before treatment (P <0.001). There were no differences between the two kinds of detection methods of PTA and TEG in acute or chronic hepatitis anddecompensated liver cirrhosis patients（P＞0.05）, but obvious differences were foundbetween compensated liver cirrhosis and liver failure patients (P=0.013, P＜0.001)。In TEG, the response time (R) after treatment (8.72) was decreased significantlythan that before treatment (23.66, P<0.001). CI (-6.6) was improved significantly thanthat before treatment (10.73, P <0.01). The improvement of CI was obviously higherthan PTA (P=0.004).A total of67times continuous blood purification (CBP) were performed in liverfailure patients. There were20times without heparin anticoagulation CRRT,2caseslasted within6hours,16cases with6to12hours,2cases with12hours or more.Coagulation routine was not changed after treatment, R value was significantlyprolonged (P=0.01), coagulation index significantly worse (P=0.009), otherparameters were not obviously changed (P>0.05). There were47cases treated withsmall dosage low molecular heparin,5cases lasted within6hours,32cases lasted6to12hours,10times more than12hours. After treatment, routine coagulation indicatorswere not significantly changed (P>0.05) in the patients with continuous bloodpurification therapy in6hours. In treatment time6-12hours group, blood coagulationtests were also no obviously changed between before and after the treatment (P>0.05).In treatment time more than12hours group, at the time treatment12hours, PTA (P=0.036), APTT (P <0.001) were significantly worse compared to those before treatment.To TEG, patients with continuous blood purification therapy in6hours, the variableswere not significantly changed (P>0.05). Treatment time6to12hours, R value (P=0.019) was at significantly extended at treatment6hours than before. Coagulation index(CI) significantly deteriorated (P <0.001). Treatment time more than12hours, R value(P=0.002), α-Angle (P=0.026) and MA (P=0.008) at12hours were obviouslychanged and coagulation index significantly worse (P <0.001).Conclusions Conventional coagulation tests and TEG in liver failure patients areworse than those in patients with compensatory phase cirrhosis and decompensatedcirrhosis. After plasma exchange treatment, conventional coagulation tests in patients with liver failure are better than those before treatment with improved PTA, INR, FIBand shortened R value, increased CI. After continuous blood purification therapy,coagulation status is getting worse, especially in TEG with the R value extends, α-angledecreases, CI reduces. TEG is the comprehensive and reliable indicator for bloodcoagulation state and may become a valuable additional tool for CBP treatment safety inliver failure patients. |
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