脑膜瘤术中自体输血对炎性反应及脑氧代谢的影响

Effects of autotransfusion on inflammation response and cerebral oxygen metabolism in the surgery of meningioma

目的观察脑膜瘤术中自体输血对IL-6、IL-8、TNF-α等炎性指标及脑氧代谢水平的影响。方法脑膜瘤患者60例,随机分为自体血组（A组）和库血组（B组）,各30例：A组回收术野非肿瘤区域出血并回输;B组依据临床输血指南输注库血。选取术前（T1）、输血后1h（T2）及4 h（T3）采样,测定血浆IL-6、IL-8、TNF-α浓度;同期经颈静脉窦和桡动脉采血样分别检测并计算：动脉、静脉血氧分压及差值（Pa O2、Pjv O2、Pa-jv O2）、二氧化碳分压及差值（Pa CO2、Pjv CO2、Pa-jv CO2）、血氧饱和度及差值（Sa O2、Sjv O2、Sa-jv O2）、乳酸含量及差值（Laca、Lacjv、ALDL）、血氧含量及差值（Ca O2、Cjv O2、Ca-jv O2）以及脑氧摄取率（CEO2）。结果两组组内三时点比较：IL-6、IL-8浓度差异有统计学意义（P〈0.01）,TNF-α浓度差异无统计学意义（P〉0.05）;与T1相比,T3时两组Pa O2、Pjv O2、HB降低,Pa CO2、PjvCO2、Lacjv升高,差异有统计学意义（P〈0.01）;T2、T3时Laca升高,差异有统计学意义（P〈0.01）;与T1相比,T3时A组Sjv O2、Pa-jv O2、Pa-jv CO2绝对值降低,Sa-jv O2、CEO2升高,差异有统计学意义（P〈0.05）;T2、T3时Ca O2降低,差异有统计学意义（P〈0.01）;T2、T3时ALDL绝对值升高,差异有统计学意义（P〈0.05）;B组与T1相比,T3时Pa-jv O2绝对值降低,T2、T3时Ca O2、Cjv O2降低,差异有统计学意义（P〈0.01）。两组组间同一时点比较：T2、T3时IL-6浓度差异有统计学差异（p〈0.05）;T3时IL-8浓度差异有统计学差异（P〈0.05）,TNF-α浓度差异无统计学意义（p〉0.05）;Pa O2、Pjv O2、Pa-jv O2、Pa CO2、Pjv CO2、Pa-jv CO2、Sa O2、Sjv O2、Sa-jv O2、Ca O2、Cjv O2、Ca-jv O2、乳酸及CEO2各时点比较差异无统计学意义（P〉0.05）。结论与输注库血相比,脑膜瘤术中自体输血所致炎性反应程度较高,但CEO2、ALDL等反映脑氧代谢水平的指标并无差别,脑氧供需平衡可维持稳定。

Objective To evaluate the impact of autotransfusion on inflammatory responses by observing the changes of IL-6,IL-8,TNF-α and its effects on cerebral oxygen metabolism in meningioma. Methods 60 patients with meningioma were randomly divided into 2 groups（ each with 30 cases） ： autotransfusion group（ A） and allogeneic transfusion group（ B）.Intraoperative bleeding of Group A was salvaged and transfused from the non-tumorous region,while the patients of group B were transfused with allogeneic blood. The blood samples were collected before transfusion（ T1）,1 h after transfusion（ T2） and4 h after transfusion（ T3） for the measurement of IL-6,IL-8 and TNF-α. Radial artery blood and sinuses jugularis blood were collected for the measurement of their oxygen gradient and differences（ Pa O2、Pjv O2、Pa-jv O2）,carbon dioxide gradient and differences（ Pa CO2、Pjv CO2、Pa-jv CO2）,blood oxygen saturation and difference（ Sa O2、Sjv O2、Sa-jv O2）,lactic acid content and difference（ Laca、Lacjv、ALDL）,blood oxygen content and difference（ Ca O2、Cjv O2、Ca-jv O2） and Cerebral extraction of oxygen（ CEO2）. Results Inter time points comparison：IL-6 and IL-8 presented statistically significant differences（ P〈0. 01）,while there was no significant difference in TNF-α（ P〈0. 05）. Compared with the condition at T1,Pa O2,Pjv O2,HB decreased while Pa CO2、Pjv CO2、Lacjv increased at T3,which is statistically significant（ P〈0. 01）; compared with T1,the Pa-jv O2、Pa-jv CO2 absolute values in group A decreased at T3,while Sa-jv O2 and CEO2 increased,the difference was statistically significant（ P〈0. 05）. Ca O2 decreased at T2 and T3,and the difference was statistically significant（ P〈0. 01）; The absolute value of ALDL increased at T2 and T3,and the differences were statistically significant（ P〈0. 05）; Compared with T1,the absolute value of Pa-jv O2 decreased at T3 while Ca O2 and Cjv O2 decreased at T2 and T3,which is statistically significant（ P〈0. 01）. Single time point comparison： IL-6 values presented statistically significant differences at T2 and T3（ P〈0. 05） between the two groups; IL-8 was statistically significant at T3（ P〈0. 05） while there was no significant difference in TNF-α（ P〈0. 05）. There was no significant differences in Pa O2、Pjv O2、Pa-jv O2、Pa CO2、Pjv CO2、Pa-jv CO2、Sa O2、Sjv O2、Sa-jv O2、Ca O2、Cjv O2、Ca-jv O2 and CEO2. Conclusion Compared with allogeneic transfusion,the degree of inflammatory reaction caused by autotransfusion was higher in the surgery of meningioma compared to the autotransfusion group. There was no difference in the levels of brain oxygen metabolism,such as CEO2 and ALDL. The balance of cerebral oxygen supply and demand was stable.