急性超容血液稀释时限制性输血对神经外科老年患者术中脑氧代谢和脑能量代谢的影响  

Effects of intraoperative restrictive transfusion as acute hypervolemic hemodilutionon on cerebral oxygen metabolism and energy metabolism in aged neurosurgical patients

作　　者：陈炜[1,2] 袁孝忠[2] 温小红[1] 黄冰[2] 周煦燕[2] 陆雅萍[2] 卢奕 杨蕊[2] 李振平[2] 刘明娟[2] 

机构地区：[1]浙江大学附属第一医院麻醉科,浙江杭州310003 [2]嘉兴市第一医院麻醉疼痛科 [3]嘉兴市第一医院神经外科

出　　处：《上海医学》2016年第4期208-213,共6页Shanghai Medical Journal

基　　金：浙江省中西医结合疼痛医学重点学科建设计划(2012-XK-A31);浙江省嘉兴疼痛医学创新团队计划(2011CX02);浙江省科技厅社会公益类资助项目(2012C33092)资助

摘　　要：目的观察急性超容血液稀释（AHHD）时限制性输血对神经外科老年患者术中脑氧代谢和脑能量代谢的影响。方法选择行神经外科手术的老年患者40例，年龄60～75岁，美国麻醉医师协会分级Ⅰ或Ⅱ级。于全身麻醉诱导平稳后，以20-30mL／min的速度静脉注射10mL／kg羟乙基淀粉行AHHD。将患者随机分入开放性输血组（输血指征为血红蛋白〈100g／L）和限制性输血组（输血指征为血红蛋白〈80g／L），每组20例。分别于行AHHD前（T1）、术中输血前（T2）、手术结束前（T3）行动静脉血气分析，测定颈静脉球血氧饱和度（SjvO2）、血糖（Glu）、血浆乳酸（Lac）等水平，并计算脑氧摄取率（CERO2）、脑氧耗量[C（a-jv）O2]、脑葡萄糖摄取率（CER Glu）和脑颈静脉球与动脉乳酸差值[D（jv-a）Lac]。结果两组T2、T3时间点的中心静脉压均显著高于同组T1时间点（P值均〈0．05），血红蛋白水平均显著低于同组T。时间点（P值均〈0．05）。开放性输血组T3时间点的血红蛋白水平显著高于同组T2时间点（P〈0．05）。限制性输血组T2、T3时间点的血红蛋白水平均显著低于开放性输血组同时间点（P值均〈0．05）。限制性输血组术中输血患者构成比和总输血量均显著低于开放性输血组（P值均〈0．05）。两组T2、T3时间点的SjvO2均显著高于同组T1时间点（P值均〈0．05），脑动脉血氧含量（CaO2）、脑静脉血氧含量（CjvO2）、C（a-jv）O2均显著低于同组T1时间点（P值均〈0．05）；T3时间点的CERO2均显著低于同组T1时间点（P值均〈0．05）。两组T2、T3时间点的动脉血乳酸（Laca）、颈静脉球部血乳酸（Lacjv）水平均显著高于同组T1时间点（P值均〈0．05），T3时间点的动脉血糖（Glu a）、颈静脉球部血糖（Glujv）水平均显著高于同组T1时间点（P值均〈0．05）。结论对于心、肺功能正常和无颅内高Objective To observe the effects of restrictive transfusion as acute hypervolemic hemodilution （AHHD） on cerebral oxygen metabolism and energy metabolism in aged neurosurgical patients. Methods Forty aged patients, aged 60-75 years old, American Society of Anesthesiologists （ASA） grade Ⅰ or Ⅱ, undergoing neurosurgery under general anesthesia were enrolled in this study. All patients were subjected to AHHD with 10 mL/kg hydroxyethyl starch solution at a rate of 20 - 30 mL/min after induction. The patients were randomly allocated to two groups： empirical transfusion group （blood transfusion indication： hemoglobin [Hb]〈 100 g/L） and restrictive transfusion group （blood transfusion indication.. Hb〈80 g/L）. There were 20 cases in each group. Arterial and bulb of jugular venous blood samples were collected before AHHD （T1）, before blood transfusion （T2） and at the end of surgery （T3） for blood gas analysis. Jugular bulb oxygen saturation （SjvO2）, blood glucose （Glu） and plasma lactic acid （Lac） levels were measured to cerebral oxygen extraction rate （CERO2）, calculate cerebral oxygen consumption （C[s-jv]O2 ）, glucose extraction rate （CER Glu） and difference between bulb of jugular vein and artery lactic acid （D（jv-a） Lac）. Results Central venous pressure at T2 and T3 was significantly higher than that at T1 （all P〈0.05）, while Hb levels at T2 and T3 were significantly lower than those at T1 in both groups （all P〈0.05）. Hb level at T3 was significantly higher than that at T2 in the empirical transfusion group （P〈0.05）. Hb level in the restrictive transfusion group were significantly lower than those in the empirical transfusion group at T2 and T3 （both P 〈 0. 05 ）. Total blood transfusion volume and patient proportion of intraoperative blood transfusion of the restrictive transfusion group were significantly lower than those of the empirical transfusion group （both P〈0.05）. In both groups, compared with the parameters a

关 键 词：急性超容血液稀释 限制性输血 神经外科 老年 脑氧代谢 脑能量代谢 

分 类 号：R614[医药卫生—麻醉学]