【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（T₁）、术中（T₂）、手术结束时（T₃）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:T₂、T₃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（CaO₂）、脑静脉血氧含量（CjvO₂）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。更多还原

【Abstract】 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 100 g/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 80 g/L.The energy metabolism index, brain oxygen metabolism index, cytokine level and cognitive function score were recorded and compared before operation（T₁）,during operation（T₂） and at the end of operation（T₃）.Results:At T₂ and T₃,the levels of Lac_a,Lac_jv,Glu_a Glu_jv,BDNF,NCF,CaO₂ and CjvO₂ in the observation group were significantly higher than those in the control group（P<0.05）,while the levels of S100 B 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.更多还原