限制性输血对神经外科老年手术患者脑能量代谢、细胞因子及认知功能的影响  

Effects of restricted blood transfusion on brain energy metabolism,cytokines and cognitive function in elderly patients after neurosurgery

作　　者：陈雪飞[1] 王秀芳 王银华 鲁怀伟[3] CHEN Xue-fei;WANG Xiu-fang;WANG Yin-hua;LU Huai-wei(Department of Laboratory Medicine,Tianchang City People's Hospital,Tianchang 239300;Intensive Care Unit,Tianchang City People's Hospital,Tianchang 239300;Department of Laboratory Medicine,Anhui Provincial Hospital,Hefei 230001,Anhui,China)

机构地区：[1]天长市人民医院,检验科,安徽天长239300 [2]天长市人民医院,重症监护室,安徽天长239300 [3]安徽省立医院检验科,安徽合肥230001

出　　处：《川北医学院学报》2021年第5期648-651,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨限制性输血对神经外科老年手术患者脑能量代谢、细胞因子及认知功能的影响。方法:选取103例神经外科老年手术患者为研究对象,按输血方式不同分为观察组(n=52)和对照组(n=51)。对照组予以开放性输血,当患者血红蛋白(Hb)水平>100 g/L时停止输血;观察组予以限制性输血,当患者Hb水平>80 g/L时停止输血。记录并比较术前(T_(1))、术中(T_(2))、手术结束时(T_(3))两组患者能量代谢指标、脑氧代谢指标、细胞因子水平、认知功能评分。结果:T_(2)、T_(3)时刻,观察组动脉血乳酸动脉血乳酸(Lac_(a))、颈静脉球部血乳酸(Lac_(jv))、动脉血糖(Glu_(a))、颈静脉球部血糖(Glu_(jv))、脑源性神经营养因子(BDNF)、神经生长因子(NCF)水平及脑动脉血氧含量(CaO_(2))、脑静脉血氧含量(CjvO_(2))高于对照组(P<0.05),S100B及MBP蛋白水平低于对照组(P<0.05);术后2 d、5 d、1周,观察组患者认知功能评分均高于对照组(P<0.05)。结论:对于老年神经外科手术患者进行限制性输血,能保持患者循环稳定,平衡脑氧代谢水平,改善神经细胞因子水平,促进认知功能的恢复。Objective:To explore the effects of restricted blood transfusion on brain energy metabolism,cytokines and cognitive function in elderly patients after neurosurgery.Methods:103 elderly patients underwent neurosurgery were selected as the research objects,according to the different ways of blood transfusion,they were divided into the observation group(n=52)and the control group(n=51).Open blood transfusion was given to the control group,and blood transfusion was stopped when the Hemoglobin(Hb)level of patients was higher than 100g/L.Patients in the observation group were given restricted blood transfusion,and the blood transfusion was stopped when the Hb level of patients was higher than 80g/L.The energy metabolism index,brain oxygen metabolism index,cytokine level and cognitive function score were recorded and compared before operation(T_(1)),during operation(T_(2))and at the end of operation(T_(3)).Results:At T_(2) and T_(3),the levels of Lac_(a),Lac_(jv),Glu_(a) Glu_(jv),BDNF,NCF,CaO_(2) and CjvO_(2) in the observation group were significantly higher than those in the control group(P<0.05),while the levels of S100B and MBP protein levels were lower than those in the control group(P<0.05).2 d,5 d and_(1) w after operation,the scores of cognitive function in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Restrictive blood transfusion for elderly neurosurgical patients can keep the patients circulation stable,balance the brain oxygen metabolism level,improve the nerve cytokine level and promote the recovery of cognitive function.

关 键 词：限制输血 脑能量代谢 细胞因子 认知功能 神经外科手术 

分 类 号：R457.1[医药卫生—治疗学]