急性等容血液稀释性血液回输对体外循环下患者术后谵妄的影响  

The influence of acute normovolemic hemodilution blood transfusion on postoperative delirium in patients undergoing cardiopulmonary bypass

作　　者：张泽鑫 吴子一 姚昊[1] Zhang Zexin;Wu Ziyi;Yao Hao(Department of Anesthesiology,The Second Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院麻醉科,南京210011

出　　处：《中国体外循环杂志》2024年第3期192-196,256,共6页Chinese Journal of Extracorporeal Circulation

基　　金：江苏省2021年省级重点研发计划(社会发展)专项资金项目(BE2021748)。

摘　　要：目的探讨急性等容血液稀释(ANH)性血液回输对体外循环下行心脏瓣膜手术患者术后谵妄(POD)的影响。方法选择2021年9月至2022年12月期间,体外循环下行瓣膜手术患者60名,按照随机数字法分为ANH组和对照组。ANH组患者在全麻下通过右侧颈内静脉三腔中心静脉导管连接含有枸橼酸钠抗凝剂的储血袋,依靠重力作用采集患者全血,并于手术结束前回输,对照组按常规手术处理。在术前(T1)、体外循环结束时(T2)、术毕(T3)取患者全血5 ml,检测并记录血清中白介素(IL)-1β、IL-6、IL-10、游离血红蛋白(FHb)浓度和脑电双频指数(BIS)值。记录两组患者术中低脑氧饱和度、POD、术后ICU停留时间、气管插管带管时间、24 h心包纵膈引流量、围术期血制品输注量及术后血管活性药物使用量等情况。结果ANH组POD发生率、IL-1β、IL-6、T2和T3时FHb的浓度、T3时的BIS值、术后24 h白细胞、C反应蛋白、乳酸值、引流量、血制品输注量以及带管时间和ICU停留时间等均低于对照组(P<0.05),血管活性药使用量亦显著减少(P<0.05);两组术中发生低脑氧饱和度及其他临床结果无明显差异(P>0.05)。结论ANH性血液回输可以降低体外循环下患者POD的发生率,其原因可能与降低患者术中炎性因子及FHb的浓度、减少血制品的输入量和术后血管活性药物的使用有关。Objective To investigate the effect of acute normovolemic hemodilution(ANH)blood transfusion on postoperative delirium(POD)in patients after cardiac valves surgery undergoing cardiopulmonary bypass.Methods 60 consecutive patients undergoing cardiac valve surgery with cardiopulmonary bypass between September 2021 and December 2022 were selected.They were randomly divided into ANH group and control group.Patients in ANH group were received whole blood from patients by connecting a blood storage bag containing sodium citrate anticoagulant via a right internal jugular three lumen central venous catheter under general anesthesia,relying on gravity action to collect their whole blood,and reinfused before the end of the procedure,while patients in control group were treated according to routine procedures.Before surgery(T1),at the end of cardiopulmonary bypass(T2),and at the end of the operation(T3),5 ml of whole blood was obtained from the patient,and the serum was tested for interleukin-1β(IL-1β)、Interleukin-6(IL-6),Interleukin-10(IL-10)、free hemoglobin(FHb),as well as bispectral index(BIS).The intraoperative low cerebral oxygen saturation,POD,postoperative ICU stay time,tracheal intubation time,24h pericardial and mediastinal drainage volume,perioperative blood product transfusion volume,postoperative vasoactive drug use were recorded.Results The incidence of POD in acute normovolemic hemodilution group was lower than that in control group(P<0.05).The concentrations of IL-1β,IL-6 and FHb in acute normovolemic hemodilution group were lower than those in control group at T2 and T3.The result of bispectral index in ANH group was lower than that in control group at T3(P<0.05).The WBC,C-reactive protein,lactate value,drainage volume,blood product infusion volume,tube time and ICU stay time in ANH group were all lower than those in control group,24 h after operation(P<0.05),and the use of vasoactive drugs was also significantly reduced(P<0.05).Intraoperative hypoxic saturation and other clinical results were not sig

关 键 词：体外循环 急性等容血液稀释 术后谵妄 炎症反应 血液保护 

分 类 号：R614[医药卫生—麻醉学]