| Objective: Myocardial injury after non-cardiac surgery is common in clinical practice,with insidious onset,usually asymptomatic,can only be detected by routine troponin monitoring,and is closely related to the postoperative mortality and the incidence of major adverse cardiovascular events.There is no safe and effective prevention method for perioperative myocardial injury,and appropriate preoperative screening is helpful to guide active postoperative preventive measures.This study was a prospective observational clinical trial.Thromboelastography parameters were used as indicators to analyze the correlation between different coagulation parameters of TEG and the occurrence of myocardial injury in patients.The occurrence of myocardial injury in patients with myocardial injury was observed.The clinical value of TEG parameters for early warning of the occurrence of myocardial injury was screened and evaluated in order to timely identify,evaluate and treat patients and implement personalized precision medicine for high-risk groups to improve the indicators.Methods: This study was an observational study.According to the inclusion and exclusion criteria,100 patients with myocardial injury who met the modified 10-year ASCVD risk score table were selected.The included patients underwent TEG coagulation test,routine anesthesia induction and maintenance.The general data of the patients were recorded,including age,gender,classification of ASA,preoperative TEG parameters,traditional blood coagulation and blood routine parameters,smoking history,history of diabetes,history of cardiovascular and cerebrovascular diseases,type of surgery,and operation time.At the end of surgery,troponin within 3 days after surgery(Myocardial injury after non-cardiac surgery was defined as peak troponin concentrations exceeding 0.03 ng/m L within 3 days after surgery)and the occurrence of major adverse cardiovascular events within 3 months after surgery were measured.(Including:Recurrent angina pectoris,non-fatal myocardial infarction,malignant arrhythmia,death from cardiovascular causes,etc.).Results: 1.General data of high-risk patients with perioperative myocardial injury selected according to the inclusion and exclusion criteria:A total of 100 subjects were finally included in this study.They were divided into non-myocardial injury group according to the troponin detection results within 3 days after operation,including 18 cases(18%)of myocardial injury and 82 cases(82%)of non-myocardial injury.There was no significant difference in age,gender,ASA grade,smoking history,history of diabetes,history of cardiovascular and cerebrovascular diseases and surgical type between the two groups(P<0.05);there was significant difference in operation time between the two groups(121.91 ± 68.29 vs 228.61 ±123.81,F = 13.96,P<0.05).2.Analysis of preoperative TEG parameters and main parameters of traditional blood coagulation routine in study subjects:In the analysis and comparison between the two groups: the α angle in TEG parameters and PLT in blood routine were significantly different between the two groups(P<0.05);while the R,K,MA and CI values in TEG parameters and PT,APTT,D-D and HB in traditional coagulation blood routine parameters were not significantly different between the two groups(P>0.05).3.Analysis of the value of α angle for early warning of MINS:The area under the ROC curve(AUC)of α angle in TEG parameters for early warning of MINS was: 0.834,P < 0.05;It was significantly higher than the area under the ROC curve(AUC)of R(0.494),K(0.343),MA(0.684)and CI value(0.594)and traditional coagulation parameters HB(0.392),PLT(0.777),PT(0.594),APTT(0.563),and D-D value(0.698)in TEG parameters;No major adverse cardiovascular events occurred within 3 months after surgery in both groups.Conclusion: In patients undergoing non-cardiac surgery,preoperative TEG detection has a good clinical early warning value for the occurrence of perioperative myocardial injury. |
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