摘要
目的探讨输血疗法预防烟雾病术后脑缺血性再损伤的有效性。方法选取烟雾病术后低血压且伴有轻度贫血患者43例,随机分为两组,实验组22例,对照组21例。实验组给予输注悬浮红细胞和新鲜冰冻血浆,比例为1:2,当红细胞压积(HCT)纠正至0.4时停止输血;对照组给予“3H”疗法,即升压、扩容、血液稀释,当平均动脉压(MAP)升高20%时停止治疗。比较两组患者治疗前后MAP、动脉血氧含量(CaO,)、局部脑血流量(rCBF)、局部脑血容量(rCBV)、局部达峰时间(rTTP)的变化。结果实验组治疗后MAP为(71±5)mmHg(1mmHg=0.133kPa)与治疗前的(55±4)mmHg比较差异有统计学意义(P〈0.05),对照组治疗后MAP为(73±6)mmHg与治疗前的(56±3)mmHg比较差异有统计学意义(P〈0.05);实验组治疗后CaO:为(17.2±1.I)mt/dl与治疗前的(14.5±1.4)mL/dl比较差异有统计学意义(P〈0.05),对照组治疗后Ca02为(15.2±1.3)ml/dl与治疗前的(14.9±1.6)ml/dl比较差异无统计学意义(P〉0.05);实验组治疗后rCBF为(2.43±0.35)ml/(100g·min)、rCBV为(1.98±0.45)rnl/(100g)、TTP为(1.89±0.47)S与治疗前的(1.02±0.07)ml/(100g·min)、(1.08±0.05)ml/(100g)、(1.21±0.29)S比较差异均有统计学意义(P〈0.05),对照组治疗后rCBF为(1.05±0.04)ml/(100g·min)、rCBV为(1.24±0.36)ml/(100g)、rTTP为(1.19±0.17)s与治疗前的(0.99±0.12)ml/(100g·min)、(1.15±0.16)ml/(100g)、(1.36±0.29)s比较差异均无统计学意义(P〉0.05)。结论悬浮红细胞联合新鲜冰冻血浆可提高烟雾病患者平均动脉乐及脯灌沣乐.增加局部腩向流量.可用于预防烟雾病术后近期脑缺血性再损伤。
Objective To investigate efficacy of blood transfusion therapy in prevention of cerebral secondary ischemia injury in patients with moyamoya disease. Methods Forty - three patients with postop- erative low blood pressure and mild anemia who suffered from moyamoya disease were divided into two groups: 22 cases in the experimental group and 21 cases in the control group. Experimental group received transfusion of red blood cells and fresh frozen plasma with a ratio of 1:2. Hematocrit (HCT) was corrected to O. 4 before discontinuation of transfusion. Control group was given "3H" therapy: hypertension, hyperv- olemia, hemodilution, and when mean arterial pressure (MAP) increased by 20% the treatment was stopped. MAP, arterial oxygen content (CaO2 ), regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional time to peak (rTrP) changes before and after treatment between the two groups were compared. Results MAP in the experimental group was ( 71 ± 5 ) mmHg ( 1 mmHg = O. 133 kPa) post- treatment and (55 ± 4) mmHg before treatment with the difference being significant ( P 〈 0. 05 ). MAP in the control group was (73 ± 6) mmHg post - treatment and (56 ± 3) mmHg before treatment with the difference being significant ( P 〈 0. 05 ). CaO/in the experimental group was ( 17.2 ± 1.1 ) ml/dl post - treatment and ( 14. 5 ± 1.4) ml/dl before treatment with the difference being significant (P 〈 0. 05 ). CaO2 in the control group was ( 15.2 ± 1.3) ml/dl post - treatment and ( 14. 9 ± 1.6) ml/dl before treatment with the difference being not significant (P 〉 0. 05 ). rCBF, rCBV, and rTTP in the ex- perimental group were (2. 43 ± 0. 35 ) ml/( 100 g" min), ( 1.98 ± 0. 45) ml/( 100 g), and ( 1.89 ± 0.47) s post -treatment and (1.02 ± 0.07) ml/(100 g.min), (1.08 ± 0.05) ml/(100 g), and (1.21 ±0. 29) sbefore treatment respectively, with the difference being significant (P 〈 0. 05). rCBF, rCBV, and rTFP in the control group were respectively (1.05 ± 0.04) mlf(100 g.min), (1.24 ± 0.36) mlf(100 g) and ( 1.19 ± 0. 17) spost - treatment, and (0.99 ± 0. 12) ml/(100 g.min), (1.15 ±0. 16) ml/( 100 g) and (1.36 ± 0. 29) sbefore treatment, with the difference being not signifi- cant (P 〉 0. 05 ). Conduslon Transfusion of red blood cells combined with fresh frozen plasma can in- crease MAP and cerebral perfusion pressure, increase regional cerebral blood flow, and can be used in the prevention of cerebral ischemia injury.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2016年第8期2000-2002,共3页
Chinese Journal of Experimental Surgery
关键词
输血
烟雾病
脑缺血性再损伤
Blood transfusion
Moyamoya disease
Cerebral secondary ischemia injury