【摘要】 目的评价红细胞输注对神经外科重症监护病房(ICU)治疗患者局部脑组织氧饱和度(rSO2)的影响。方法选取在2017年7月至2019年6月在该院神经外科ICU治疗的38例患者,在红细胞输注前、输注结束以及输注后6、12、18和24h检测患者rSO2,同时检测患者血红蛋白、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)和体温。计算动脉氧含量(CaO2)、中心静脉氧含量(CcvO)和脑氧摄取分数(CFOE)。评价患者红细胞输注前和输注后24h上述指标的变化。结果输注后患者CaO2(F=4.457,P<0.001)、CcvO2(F=7.022,P<0.001)与ScvO2(F=3.487,P=0.005)较红细胞输注前(基线期)显著提高,氧提取分数(OE)较基线期显著降低(F=7.022,P=0.001)。在研究期间,患者系统性血液动力学指标如心率(HR,F=0.858,P=0.970)和CVP(F=0.725,P=0.610),血流灌注指数(F=1.520,P=0.184)和灌注变异指数(F=0.611,P=0.695)与基线期比较均未发生显著变化。红细胞输注6h后,患者脑损伤侧与脑正常侧rSO2较基线期均显著提高(P<0.05),并在红细胞输注后24h持续保持高水平,而CFOE显著降低(P<0.05)。结论红细胞输注能够增加神经外科ICU住院患者脑组织氧饱和度。神经外科和输血科临床医师应当根据患者rSO2变化情况,对患者进行更加合理、有效的红细胞输注治疗。更多还原

【Abstract】 Objective To evaluate the effect of red blood cell transfusion on regional brain oxygen saturation(rSO2)in neurosurgical intensive care unit(ICU)patients.Methods A total of 38 patients who applied for neurosurgical ICU treatment in the hospital from July 2017 to June 2019 were enrolled.RSO2 was measured before red blood cell transfusion,at the end of transfusion and at 6,12,18 and 24 hours after transfusion.Hemoglobin,central venous pressure(CVP),systemic central venous oxygen saturation(ScvO2)and body temperature were also measured.The arterial oxygen content(CaO2),central-venous oxygen content(CcvO2)and cerebral fractional oxygen extraction(CFOE)were calculated.The changes of above indexes before and 24 hours after erythrocyte infusion were evaluated.Results CaO2(F=4.457,P<0.001),CcvO2(F=7.022,P<0.001)and ScvO2(F=3.487,P=0.005)were significantly increased and oxygen extraction(OE)was significantly decreased compared with baseline period(F=7.022,P=0.001).Systemic hemodynamic parameters such as heart rate(HR,F=0.858,P=0.970)and CVP(F=0.725,P=0.610),tissue perfusion index(F=1.520,P=0.184)and perfusion variation index(F=0.611,P=0.695)did not change significantly during the study period.After red blood cell transfusion for 6 hours,rSO2 in the injured side and the normal side of the brain increased compared with baseline period significantly(P<0.05),and remained at a high level 24 hours after erythrocyte infusion,while CFOE decreased significantly(P<0.05).Conclusion Red blood cell transfusion can increase brain oxygen saturation in neurosurgical ICU inpatients.Neurosurgery and transfusion clinicians should treat ICU patients with more reasonable and effective red blood cell transfusion according to the changes of rSO2.更多还原