预存式自体输血和异体输血对老年脑外科手术患者脑组织氧合和乳酸代谢的影响

摘要

Objective To evaluate the effects of pre-stored autologous and allogeneic blood transfusion on brain oxygenation and lactic acid metabolism in the elderly patients with cerebral surgery.Methods Eighty-six patients with cerebral surgery in our hos-pital were divided into autologous and allogeneic groups,43 in each group.The allogeneic group was treated with allogeneic blood trans-fusion,and the autologous group was given pre-existing autologous blood transfusion. The cerebral oxygenation metabolism,cognitive function and serum levels of TNF-(,IL-6 and IL-10 before and after operation,postoperative complications and adverse reactions of blood transfusion were compared between the two groups.Results The cerebral oxygen consumption and formation of lactic acid were lower and cerebral oxygen uptake rate was higher in the autologous group after 1d,3d and 7d of blood transfusion than those in the al-lograft group (P < 0.05).The postoperative MoCA score in the autologous group was higher than that in the allograft group (P <0.05).The postoperative 7d levels of TNF-(and IL-10 were significantly higher while IL-6 level was significantly lower in the autolo-gous group after operation than those in the allograft group(P<0.05).The incidence of complications and adverse reaction rate in the autologous group was lower than those in the allograft group(P<0.05).Conclusion Pre-stored autologous blood transfusion can im-prove the cerebral oxygenation metabolism and cognitive function in patients with cerebral surgery and reduce the inflammatory reaction after operation,the incidence of infectious complications and the adverse reactions.It is beneficial for postoperative outcome.%目的 探讨预存式自体输血和异体输血对老年脑外科手术患者脑组织氧合和乳酸代谢的影响.方法 我院确诊治疗的脑外科手术患者86例,按随机数字表法分为自体组和异体组各43例.异体组给予异体输血治疗,自体组给予预存式自体血回输治疗,比较两组术前、术后脑氧合代谢指标和认知功能,血清TNF-α、IL-6和IL-10水平,术后并发症和输血不良反应发生情况.结果 自体组术后1、3、7 d脑氧耗、乳酸生成量低于异体组,脑氧摄取率高于异体组;术后3 d MoCA评分高于异体组;术后7 d TNF-α、IL-10水平高于异体组,IL-6水平低于异体组;并发症和输血不良反应发生率均低于异体组(P<0.05).结论 预存式自体输血可改善脑外科手术患者脑氧合代谢指标和认知功能,降低术后炎性反应,减少感染性并发症和输血不良反应发生率,有利于术后转归.