洗涤式自体血回输对非停跳冠脉搭桥术患者脑氧代谢的影响  

Effect of washed autologous blood transfusion on cerebral oxygen metabolism in patients with off-pump coronary artery bypass surgery

作　　者：徐霞[1] 胡礼宏 XU Xia;HU Lihong(Department of Anesthesiology,Ningbo City Medical Treatment Center Lihuili Hospital,Ningbo 315000,China;Department of Anesthesiology,Ningbo City Medical Treatment Center Lihuili Eastern Hospital,Ningbo 315000,China)

机构地区：[1]宁波市医疗中心李惠利医院麻醉科,浙江宁波315000 [2]宁波市医疗中心李惠利东部医院麻醉科,浙江宁波315000

出　　处：《中国现代医生》2018年第13期1-4,9,共5页China Modern Doctor

基　　金：浙江省宁波市医学科技计划项目(2016A42)

摘　　要：目的探讨洗涤式自体血回输对非停跳冠脉搭桥术患者脑氧代谢的影响。方法选择择期行非停跳冠脉搭桥术患者60例,随机分为对照组和观察组,对照组根据需要输入异体血,观察组采用洗涤式自体血回输,再根据需要输入适量异体血。于术前(T_1)、术毕(T_2)和术后24 h(T_3),经颈内静脉球部和桡动脉采血行血气分析,计算CERO_2、SjvO_2、Da-jvO_2和VADL等指标,并记录术中和术后24 h内异体输血例数和输血量,于术前1 d和术后1、3和7 d采用术后简易智能状态检查法评定术后认知功能障碍(POCD)的情况。结果观察组异体输血例数和输血量显著低于对照组,观察组POCD发生率显著低于对照组,Da-jvO_2和CERO_2在对照组内各点比较无显著性差异,观察组Da-jvO_2和CERO_2在T_2和T_3显著低于T_1和对照组(P<0.05),对照组SjvO_2在T_2显著高于T_1。观察组SjvO_2在T_2和T_3显著高于T_1和对照组(P<0.05)。VADL在两组内和组间比较无显著性差异(P>0.05)。结论洗涤式自体血回输应用于非停跳冠脉搭桥术患者可以有效维持循环稳定,减少异体血输入,增加患者脑组织氧供,降低脑氧耗。Objective To investigate the effect of washed autologous blood transfusion on cerebral oxygen metabolism in patients with off-pump coronary artery bypass surgery. Methods 60 patients who would undergo off-pump coronary artery bypass surgery were randomly divided into control group and observation group. The control group received allogeneic blood as needed. The observation group received washed autologous blood transfusion and the right amount of allogeneic blood as needed. Blood were collected from the internal jugular vein and the radial artery before surgery（T1）,at the end of the surgery（T2） and 24 h after the surgery（T3） to perform blood gas analysis, in order to calculate indexes of CERO2, Sjv O2, Da-jv O2 and VADL. Cases and amount of allogeneic transfusion were recorded during operation and24 h after the surgery. Postoperative cognitive dysfunction（POCD） was assessed by postoperative simple intelligent examination method on the first day before operation and 1, 3 and 7 days after operation. Results The cases and amount of allogeneic transfusion in the observation group were significantly lower than those in the control group. The incidence of POCD in the observation group was significantly lower than the control group. Da-jv O2 and CERO2at T1, T2 and T3in the control group showed no significant difference. Da-jv O2 and CERO2of the observation group in T2 and T3were significantly lower than T1 and control group（P〈0.05）. Sjv O2 in control group was significantly higher in T2 than T1,and Sjv O2 in T2and T3 in observation group were significantly higher than T1 and control group（P〈0.05）. There was no significant difference in VADL between the two groups（P〈0.05）. Conclusion The application of washed autologous blood transfu sion in off-pump coronary artery bypass surgery can effectively maintain the circulation stability, reduce allogeneic transfusion, increase oxygen supply to brain tissue and reduce cerebral oxygen consumption.

关 键 词：自体血回输 冠脉搭桥术 脑氧代谢 术后认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]