| Objective: To investigate the retrospective study of perioperative coagulation function in cancer patients,evaluate the differences of perioperative coagulation function in patients with different cancers by means of thromboelastography and routine coagulation indexes,and explore the influence of individual factors such as age? body mass index?smoking ?chemotherapy history on coagulation function.Methods: 2061 patients who underwent elective cancer resection in the first affiliated hospital of chongqing medical university from August2018 to July 2019 were collected as the observation group,and 382 patients who underwent elective benign tumor resection in our hospital during the same period were selected as the control group for a retrospective study.Preoperative visit records and patients by medical record system name,gender,age,medical record number,and grade of ASA,smoking history,operation date,diagnosis,surgical basic information such as name,performer,and preoperative routine coagulation indexes(PT,a PTT and Fib,D-dimer,etc.),blood routine indexes(such as HGB,Hct)laboratory indicators.After entering the room,the radial artery was punctured before anesthesia induction.2.7ml of arterial blood was collected and injected into an anticoagulant tube of citrate(BD company 0.109m).After being placed at room temperature for 15 min-2 hours,TEG indexes(R,K,MA)were measured in the operating room.Results:1.A total of 2061 patients with cancers were collected in the observation group,including 979 males and 1082 females.The ratio of men to women is 1:1.15,average age were 58 years old,among them 399 cases are suffed from breast cancer,575 cases of lung cancer,334 colon cancer,157 cervical cancer,62 cases esophageal cancer,109 cases of liver cancer,64 cases of prostate cancer,47 bladder cancer,70 cases of laryngeal cancer,112 cases of gastric cancer,45 kidney cancer,46 cases of pancreatic cancer,41 cases ovarian cancer,were thirteen kinds of cancer,the rest of the types of cancer has less number of cases is not included in the study.Control group were collected 382 patients with benign tumor,among which 181 were male,female 201 cases,The ratio of men to women is 0.9:1.Among them,there were 8 cases of hepatic hemangioma,19 cases of parotid gland tumor,15 cases of pelvic cavity tumor,80 cases of mediastinal tumor,28 cases of non-functional pituitary tumor,30 cases of cervical benign tumor,50 cases of intracranial benign tumor,42 cases of sellar benign tumor,21 cases of adrenal benign tumor and 89 cases of thyroid benign tumor the rest of the type of benign tumor has less number of cases is not included in the study..2.Compared with the benign tumor group,the R?K?MA?PT value in the cancer group indicates hypercoagulability(P < 0.05).There was no significant difference in APTT value between the cancer group and the benign tumor group(P > 0.05).3.Compared with male patients with malignant tumor,there were obvious differences in TEG parameters R value,K value and a Angle in cancer female patients(p < 0.05),indicating hypercoagulability.Compared with cancer male patients there was no significant difference in MA value(p >0.05).4.The K value detected by TEG and the APTT value of routine coagulation indicator were negatively correlated with age(coefficient of association:-0.63,p=0.005,coefficient of association:-0.254,p=0.013).The older the age,the smaller the K value and APTT value were,coagulation factor activity was enhanced.The Angle and MA value of TEG test were positively correlated with age(coefficient of association: 0.82,p=0.000,coefficient of association: 0.59,p=0.01).With the increase of age,the Angle and MA values increased,indicating increased fibrinolytic activity and hyperactivity of platelets.TEG R value,PT value,d-dimer and FBG were not correlated with the age.Conventional coagulation indexes PT and a PTT were highly negatively correlated with BMI(coefficient of association:-0.278,p < 0.001;coefficient of association:-0.278,p < 0.001),with the increase of BMI,the PT value and a PTT value decreased,and the coagulation factor activity increased.The values of d-dimer and Fib were positively correlated with BMI(coefficient of association: 0.166,p <0.01;Correlation coefficient: 0.124,p < 0.08).With the increase of BMI,the values of d-dimer and Fib increased,suggesting enhanced fibrinolytic activity.There was no correlation between R value,K value,Angle of Angle and MA value of TEG parameters and BMI.5.The R value of TEG parameter was positively correlated with PT value and APTT value of routine coagulation index(coefficient of association: 0.148 p: 0.035,correlation coefficient: 0.174 p: 0.013),and the MA value of TEG parameter was positively correlated with PT value,APTT value,and d-dimer value of routine coagulation test.(coefficient of association: 0.149 p=0.034,coefficient of association: 0.153 p=0.030 coefficient of association: 0.159 p =0.024).The other indicators were not correlated.6.Correlation analysis of TEG parameters showed that R was positively correlated with K(coefficient of association=0.442,p=0.000),and MA was positively correlated with Angle(coefficient of association=0.457,p=0.000).Angle a is negatively correlated with K value(coefficient of association=-0.926 p=0.000),MA value and K value(coefficient of association=-0.828 p=0.000),Anglea and R value(coefficient of association=-0.598,p=0.000),MA value and R value(coefficient of association=-0.092 p=0.000).The R and K values were shortened,and the a Angle and MA values were increased,indicating that the coagulation factors was enhanced,the level of fibrinogen was enhanced,and the function of platelets was strong.The R and K values increase,while the Angle and MA decrease.The activity of coagulation factor was reduced.Fibrinogen level is low and platelet function is weak.7.There were significant differences in TEG parameters among patients with different malignant tumors,all of which were significant(P <0.05),while no significant differences were found in conventional coagulation indexes PT and APTT(P > 0.05).8.Comparison of TEG and routine blood clotting indicators in male patients with malignant tumor in patients with different smoking histories.Results analysis: there was no significant difference in TEG and routine coagulation indexes between patients with and without smoking history(P >0.05).9.Among the 2,061 cancer patients,a total of 452 patients had a history of preoperative chemotherapy(103 cases of breast cancer,73 cases of colon cancer,77 cases of cervical cancer,77 cases of gastric cancer,51 cases of lung cancer,75 cases of liver cancer,34 cases of prostate cancer).Compared with the group without a history of chemotherapy,the TEG test indicators in the group with a history of chemotherapy were significantly different(P < 0.05),suggesting that patients with a history of chemotherapy had more severe hypercoagulability.There was no difference between the conventional blood coagulation indexes(P >0.05).Conclusions: 1.Compared with patients with benign tumors,patients with cancers showed hypercoagulability.2.TEG parameters were significantly correlated with the detection of conventional coagulation indicators,with detection consistency.3.Among the cancer patients,the advanced age,female,high BMI and previous history of chemotherapy showed relatively high coagulation state.Smoking has not been found to have a significant effect on blood coagulation.4.There were differences in perioperative coagulation function among patients with different malignant tumors.Among them,colon cancer,breast cancer,cervical cancer,ovarian cancer compared with the control group,coagulation function is abnormal,hypercoagulability is more obvious... |
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