脑膜瘤术中自体输血对炎性反应及脑氧代谢的影响  

Effects of autotransfusion on inflammation response and cerebral oxygen metabolism in the surgery of meningioma

作　　者：郭佩垒[1] 胡强夫[1] 聂晓红[1] 李晓培[1] 李渊[1] GUO Peilei;HU Qiaugfu;NIE Xiaohong;LI Xiaopei;LI Yuan(Department of Anesthesiology,The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院麻醉科

出　　处：《中国输血杂志》2018年第6期623-627,共5页Chinese Journal of Blood Transfusion

基　　金：河南省高等学校重点科研项目(15A320067)

摘　　要：目的观察脑膜瘤术中自体输血对IL-6、IL-8、TNF-α等炎性指标及脑氧代谢水平的影响。方法脑膜瘤患者60例,随机分为自体血组（A组）和库血组（B组）,各30例：A组回收术野非肿瘤区域出血并回输;B组依据临床输血指南输注库血。选取术前（T1）、输血后1h（T2）及4 h（T3）采样,测定血浆IL-6、IL-8、TNF-α浓度;同期经颈静脉窦和桡动脉采血样分别检测并计算：动脉、静脉血氧分压及差值（Pa O2、Pjv O2、Pa-jv O2）、二氧化碳分压及差值（Pa CO2、Pjv CO2、Pa-jv CO2）、血氧饱和度及差值（Sa O2、Sjv O2、Sa-jv O2）、乳酸含量及差值（Laca、Lacjv、ALDL）、血氧含量及差值（Ca O2、Cjv O2、Ca-jv O2）以及脑氧摄取率（CEO2）。结果两组组内三时点比较：IL-6、IL-8浓度差异有统计学意义（P〈0.01）,TNF-α浓度差异无统计学意义（P〉0.05）;与T1相比,T3时两组Pa O2、Pjv O2、HB降低,Pa CO2、PjvCO2、Lacjv升高,差异有统计学意义（P〈0.01）;T2、T3时Laca升高,差异有统计学意义（P〈0.01）;与T1相比,T3时A组Sjv O2、Pa-jv O2、Pa-jv CO2绝对值降低,Sa-jv O2、CEO2升高,差异有统计学意义（P〈0.05）;T2、T3时Ca O2降低,差异有统计学意义（P〈0.01）;T2、T3时ALDL绝对值升高,差异有统计学意义（P〈0.05）;B组与T1相比,T3时Pa-jv O2绝对值降低,T2、T3时Ca O2、Cjv O2降低,差异有统计学意义（P〈0.01）。两组组间同一时点比较：T2、T3时IL-6浓度差异有统计学差异（p〈0.05）;T3时IL-8浓度差异有统计学差异（P〈0.05）,TNF-α浓度差异无统计学意义（p〉0.05）;Pa O2、Pjv O2、Pa-jv O2、Pa CO2、Pjv CO2、Pa-jv CO2、Sa O2、Sjv O2、Sa-jv O2、Ca O2、Cjv O2、Ca-jv O2、乳酸及CEO2各时点比较差异无统计学意义（P〉0.05）。结论与输注库血相比,脑膜瘤术中自体输血所致炎性反应程度较高,但CEO2、ALDL等反映脑氧代谢水平的指标并无差别,脑氧供需平衡可维持稳定Objective To evaluate the impact of autotransfusion on inflammatory responses by observing the changes of IL-6,IL-8,TNF-α and its effects on cerebral oxygen metabolism in meningioma. Methods 60 patients with meningioma were randomly divided into 2 groups（ each with 30 cases） ： autotransfusion group（ A） and allogeneic transfusion group（ B）.Intraoperative bleeding of Group A was salvaged and transfused from the non-tumorous region,while the patients of group B were transfused with allogeneic blood. The blood samples were collected before transfusion（ T1）,1 h after transfusion（ T2） and4 h after transfusion（ T3） for the measurement of IL-6,IL-8 and TNF-α. Radial artery blood and sinuses jugularis blood were collected for the measurement of their oxygen gradient and differences（ Pa O2、Pjv O2、Pa-jv O2）,carbon dioxide gradient and differences（ Pa CO2、Pjv CO2、Pa-jv CO2）,blood oxygen saturation and difference（ Sa O2、Sjv O2、Sa-jv O2）,lactic acid content and difference（ Laca、Lacjv、ALDL）,blood oxygen content and difference（ Ca O2、Cjv O2、Ca-jv O2） and Cerebral extraction of oxygen（ CEO2）. Results Inter time points comparison：IL-6 and IL-8 presented statistically significant differences（ P〈0. 01）,while there was no significant difference in TNF-α（ P〈0. 05）. Compared with the condition at T1,Pa O2,Pjv O2,HB decreased while Pa CO2、Pjv CO2、Lacjv increased at T3,which is statistically significant（ P〈0. 01）; compared with T1,the Pa-jv O2、Pa-jv CO2 absolute values in group A decreased at T3,while Sa-jv O2 and CEO2 increased,the difference was statistically significant（ P〈0. 05）. Ca O2 decreased at T2 and T3,and the difference was statistically significant（ P〈0. 01）; The absolute value of ALDL increased at T2 and T3,and the differences were statistically significant（ P〈0. 05）; Compared with T1,the absolute value of Pa-jv O2 decreased at T3 while Ca O2 and Cjv O2 decreased at T2 and T3,which is statistically significant

关 键 词：脑膜瘤 自体输血 白细胞介素6 白细胞介素8 肿瘤坏死因子α 脑氧摄取率 

分 类 号：R457.1[医药卫生—治疗学] R739.45[医药卫生—临床医学]