Evaluation Of Coagulation Function In Patients Undergoing Single Or Double Valves Replacement Under Cardiopulmonary Bypass By Thromboelastography

Objective The pioneering technology of cardiopulmonary bypass(CPB)has made open-heart surgery possible,and made cardiac surgery developing rapidly since the 1950 s.But it may lead to complex pathophysiological changes in the body,and has greater influence on the coagulation mechanism.Therefore,it is particularly important to assess the coagulation function of patients undergoing cardiac surgery.The aim of this study was to evaluate the changes of coagulation function in patients with single or double valve(s)replacement under CPB by thromboelastography(TEG).Then we can identify the causes of bleeding which could guide the clinical treatment in these patients during the operation.Methods Eighty-five patients who underwent valve replacement operation in First Affiliated Hospital of Anhui Medical University from November 2015 to May 2016,no gender limitation,aged 40~76 year,weighted 34~86kg,ASA graded II~ III,NYHAgraded II~ III,were enrolled in this study.Among them,41 patients underwent double valves replacement(aortic valve + mitral valve),44 patients underwent single valve replacement(aortic valve or mitral valve).All patients were treated with tracheal intubation general anesthesia.The central venous blood before heparinization was used to citratedkaolin TEG(CK-TEG)assay and the blood 5min after protamine neutralization heparin was used to citratedkaolin TEG and citratedkaolin with heparinase TEG(CKH-TEG)assay.TEG test results and the incidence of abnormal results were compared between the two groups of patients with pre-CPB and post-CPB.Statistical analysis was performed by SPSS16.0 software package.And P<0.05 was considered statistically significant.Results 1.General clinical data:there was no significant difference(P>0.05)between the two groups on gender,age,weight,preoperative ACT values,and ACT values after neutralizing heparin;2.CPB time: double vavles group was longer than single vavle group on CPB time;3.There was no statistically significant difference in TEG indicators between the two groups before heparinization(P>0.05);there was no significant difference in the incidence of TEG abnormality after neutralizing heparin(P>0.05),but the total number of abnormal TEG cases was statistically significant betwen the groups(P<0.05).Significant difference was observed in the change of R,MA and CI after neutralizing heparin(P <0.05),and the rest indicators was statistically significant betwen the groups(P <0.05).4.We also found the changes of R,K,Angle,MA,CI had statistically significant(P<0.05)in postoperation compared to the preoperration in single vavle group,and the changes of LY30,the incidence of TEG abnormality and the total number of abnormal TEG cases had no statistically significant(P>0.05)betwen the groups.The changes of various indicators(R,K,Angle,MA,CI,LY30,the total number of abnormal TEG cases)was statistically significant(P<0.05)in postoperation compared to the preoperration in double vavles group,and the change of he incidence of TEG abnormality was not statistically significant(P>0.05)betwen the groups.Conclusion Our study showed the coagulation function was obviously changed in patients undergoing valve replacement after CPB,and it has greater decrease in the coagulation factor,fibrinogen,platelet function and quantity.The change of coagulation funtion can included the fibrinolytic hyperthyroidism.The result also showed the double valves replacement group has greater changed compared with the single valve replacement group,and TEC can be used to determine the causes of hemorrhaging after ending extracorporeal circulation and guide the clinical treatment.