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Evaluation of the application of Sonoclot analyzer in coronary artery bypass grafting

[abstract] objective: to monitor the changes of coagulation function in the extracorporeal circulation (ECC) coronary artery bypass grafting (CABG) by Sonoclot platelet function analyzer. Methods: randomly selected 20 cases of ECC downward CABG patients, before induction of general anesthesia (T1), 10 min after downtime and protamine neutralization (T2) and end (T3) after surgery and blood samples, detection of platelet function and ACT, PT, APTT, Fib, TT and Hb. Results: compared with T1, T2 and T3, PT, APTT and TT were extended, Fib decreased, ACT extended, CR and PF decreased, and T3 and T2 reduced clotting time. Conclusion: Sonoclot analyzer can accurately monitor the changes of coagulation function after ECC.
[keywords] platelet function analyzer; Coagulation function; Extracorporeal circulation
Abstract Objective: To monitor the changes in blood coagulation with sonoclot platelet functional analyzer during extracorporeal circulation (ECC) coronary artery bypass grafting(CABG). Methods: Twenty cases with CABG were randomly selected. Blood was taken to test platelet function, ACT, PT, APTT, Fib, TT, and Hb before induction of general anesthesia (T1), at 10 min after protamin neutralization (T2), and at the end of surgery (T3). Results: Compared with those at T1, the value at T2 and T3 of PT, APTT, TT and ACT increased, CR, PF and Fib decreased. Moreover, compared with T2, coagulation time decreased at T3. Conclusion: Sonoclot analyzer can monitor the changes in coagulation function after ECC.

Abstract Objective: To monitor the changes in blood coagulation with sonoclot platelet functional analyzer during extracorporeal circulation (ECC) coronary artery bypass grafting(CABG). Methods: Twenty cases with CABG were randomly selected. Blood was taken to test platelet function, ACT, PT, APTT, Fib, TT, and Hb before induction of general anesthesia (T1), at 10 min after protamin neutralization (T2), and at the end of surgery (T3). Results: Compared with those at T1, the value at T2 and T3 of PT, APTT, TT and ACT increased, CR, PF and Fib decreased. Moreover, compared with T2, coagulation time decreased at T3. Conclusion: Sonoclot analyzer can monitor the changes in coagulation function after ECC.

Key words Platelet functional analyzer; Coagulation function; Extracorporeal circulation
Extracorporeal circulation (extracorporeal circulation, ECC) can cause human body blood coagulation function change, ECC caused by coagulation dysfunction after surgery than WaiKeXing hemorrhage and thrombosis complications incidence is 0.4% ~ 3% [1], the main reason with ECC during coagulation, anticoagulant and fibrinolytic system function and platelet (PLT) function associated with the change of the number. Wang shiang et al. [2] believed that the Sonoclot analyzer could detect the changes of coagulation function in vitro after early detection. This article through to Sonoclot clotting and PLT function analyzer with conventional coagulation detection of coronary artery bypass graft surgery under extracorporeal circulation ECC before and after the change of the blood coagulation function, to improve the detection of heart perioperative blood coagulation dysfunction and provide basis for processing.
1 data and methods
1.1 clinical data
There were 20 patients with ECC coronary artery bypass grafting patients, no blood system and severe liver and kidney disease before surgery, and anticoagulant drugs such as aspirin before operation 7 ~ 10 d. Among them, 13 males and 7 females, aged 51 ~ 72 years, average age of 63.1 years; Weight 64 ~ 100 kg, average weight 73.1 kg; ASA class Ⅱ ~ Ⅲ, heart function Ⅱ ~ Ⅲ level. There were 8 cases of aged heart stem, 10 cases of hypertension and 8 cases of diabetes mellitus.
1.2 method
All patients were induced by imidazolam, sufentanil, etomidate, and rocuronium bromide, and fentanyl, propofol, isoflurane, piperium bromide were used to maintain anesthesia. Intravenous heparin 400 IU/kg, ACT>480 s as the transit indicator. The ECC used membrane oxygenator (Terumo, Japan), and the prefilling fluid was 10,000 mL, and the boll force 500mL. The method of suspension was used Buckberg, s method, low temperature 90 % non - pulsing perfusion, and the routine application of ammonia - toluric acid 10 mg/kg. After the operation, the heart is automatically or defibrillated, and after the shutdown, the fish protein 1:1:1 neutralizing heparin. Additional fish protein is added according to ACT value and wound bleeding, and fresh plasma or floating red blood cells are injected when necessary. During the operation, the Cell saver(Dideco,Italy) was used for washing and recycling, before the operation was completed.
1.3 observation indexes
Before anesthesia induction (T1), 10 min after downtime and protamine neutralization (T2) and (T3) venous blood was collected at the end of the operation, using Sonoclot (Sienco, USA) determination of whole blood activated clotting time (gbACT), blood coagulation rate (CR), PLT function (PF), Japan Sysmex kx - 21 blood analyzer measurement of hemoglobin (Hb), PLT count, Japan Sysmex ca - 550 blood analyzer to measure the plasma prothrombin time (PT), activated partial clotting enzyme live time (APTT), thrombin time (TT), fibrinogen (Fib).
1.4 statistical processing
The data in the group were represented by x plus or minus s, and the SPSS 12.0 software was used for statistical processing, and the variance analysis of the repeated measurement data was compared at each time point. P<0.05 was statistically significant.
2 the results
The time of transfer in this group was 96.45 plus or minus 34.55 min, and the aortic dissection time was 78.95 or 32.14 min. Compared with pre-anesthesia, the Hb and PLT were reduced after shutdown and after surgery, PT, APTT, TT extended, Fib decreased, ACT, gbACT extended, CR and PF values decreased, and the differences were statistically significant (P<0.05 or P< 0.01). After the comparison with the shutdown, the Hb and PLT count recovered, the coagulation time shortened, and the Fib increased, and the difference was statistically significant (P<0.05 or P< 0.01). See table 1, table 2. Table 1 routine check indicator table 2 ACT and Sonoclot PLT function indicators
3 discuss
ECC because blood and artificial materials in contact, WBC and PLT were activated and degranulation, lack of clotting factors, blood loss and dilution, low temperature, physical damage, the role of heparin and protamine compounds, as well as the use of the preoperative PLT drugs, many abnormal function of patients with preoperative PLT, often associated with postoperative bleeding. The study confirmed that the PLT function, quantity and the damage of coagulation function induced by ECC were the main causes of abnormal bleeding after cardiac surgery [3].
This group of patients with coronary artery bypass graft surgery, preoperative application of drug PLT, both to treat postoperative surgical bleeding, and to take into account the high coagulation state caused by excessive treatment caused bridge vascular occlusion, and therefore to evaluate perioperative PLT function is particularly important [4-5]. Pure ACT does not accurately judge hemorrhage reason, conventional PT, APTT, TT can only reflect some aspect of blood coagulation mechanism, its detection in the formation of fibrin monomer, the end, can't reflect the whole process of coagulation cascade and blood coagulation system internal condition; Traditional PLT gathered turbidity analysis is still a clinical standard way to detect the PLT function, but time-consuming, laborious, expensive, need transit operation, and high in PLT plasma at low shear force state of the completed tests are not accurate simulation itself hemostatic state [5]. Sonoclot by detect fibrin formation, fibrin monomer polymerization, the interaction of PLT, blood clot retraction and dissolve make us understand the whole process of blood coagulation [6], can accurately evaluate ECC PLT dysfunction and coagulation function after damage [7], and can be done next to the bed, save time, real-time and accurately. Ferraris VA etc. [8] studies confirm Sonoclot can provide real-time accurate blood coagulation function evaluation, for heparin anticoagulation, protamine neutralization, postoperative bleeding treatment provides guidance, and to guide clinical rational use of blood products and astringent blood, reduce the blindness in application, saving resources, reduce hospitalization expenses [9].
Because the Sonoclot analyzer's results were criticized by age, gender, and the number of PLT, the study showed that some variables have poor repeatability, especially CR and PF. In order to overcome the above shortcomings, this paper will evaluate PLT function more accurately with the detection of Sonoclot analyzer and the combination of PLT count and conventional coagulation detection. This research shows that, 10 min after downtime and compared with before the end of the surgery and anesthesia, various testing indexes have different degree of decline, demonstrate how conventional coagulation and Sonoclot analyzer can be used in patients with coronary artery bypass graft surgery under the ECC coagulant function testing. Compared with the 10 minutes after the operation, PT, APTT, TT and Fib improved and the differences were statistically significant, and although the ACT, CR and PF had improved, the differences were not statistically significant. Due to the influence of high volume of blood dilution (the difference of Hb in T2 and T3 is statistically significant), Sonoclot is considered to be less affected by blood dilution. Due to the short observation time, it is not possible to observe the time of recovery of coagulation function. Further study is needed.
This study argues that Sonoclot analyzer can provide the whole process of whole blood coagulation state information, for clinical provides another rapid bedside detection method, the detection sensitivity is superior to the conventional coagulation function.
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