急性高容量血液稀释对脑动脉瘤夹闭患者认知功能、血清S-100β和氧代谢的影响

Effect of acute hypervolemic hemodilution on cognitive function, serum S-100β and oxygen metabolism in patients with cerebral aneurysm clipping

摘要:

目的  探讨急性高容量血液稀释（AHH）对脑动脉瘤夹闭患者认知功能、血清S-100β和氧代谢的影响。方法  选取行脑动脉瘤夹闭术的60例患者，随机分为AHH组与对照组，每组30例，均在气管插管全麻下进行手术，AHH组同时实施AHH，观察患者麻醉诱导后即刻（T0）、血液稀释15 min（T1）、血液稀释60 min（T2）、手术结束时（T3）、术后3 d（T4）时颈静脉血氧饱和度（SjvO2）、脑动静脉血氧含量差（AVDO2）、血清S-100β，术前、术后7 d时患者认知功能(MMSE、LOTCA)变化。结果  两组术中液体输入量、出血量、尿量、手术时间比较差异无统计学意义（P >0.05）；SjvO2、AVDO2、S100β在不同时点比较差异有统计学意义（P <0.05），AHH组与对照组不同时点比较差异有统计学意义（P <0.05）；MMSE、LOTCA在不同时点比较差异无统计学意义（P >
0.05），AHH组与对照组不同时点比较差异无统计学意义（P >0.05）。结论  AHH对脑动脉瘤夹闭患者早期脑氧代谢有影响，可引起短暂脑损伤，但对患者认知功能无明显影响。

Abstract:

Objective To explore effect of acute hypervolemic hemodilution(AHH) on cognitive function, serum S-100β and oxygen metabolism in patients with cerebral aneurysm clipping. Methods A total of 60 patients with clipping of cerebral aneurysm were selected and randomly divided into AHH group and control group, each of 30 cases. All the operations were performed under general anesthesia with tracheal intubation. The AHH group was performed AHH at the same time. The value of saturation jugular venous oxygen (SjvO2), cerebral arteriovnous oxygen difference (AVDO2) and S-100β at the following time points were collected: immediately after anesthesia induction (T0), blood dilution 15 min (T1), blood dilution 60 min (T2), at the end of surgery (T3), postoperative 3 d (T4). Cognitive functions (MMSE and LOTCA) preoperatively and 7 d post-operatively in patients were compared. Results Intraoperative fluid input, blood loss, urine volume, operation time had no significant difference between the two groups (P > 0.05). SjvO2, AVDO2, S-100β, in different time points had statistically difference (P < 0.05), and the difference was statistically significant between  two groups (P < 0.05). MMSE and LOTCA had no statistically difference in different points (P > 0.05). Conclusions Effect of AHH on cerebral oxygen metabolism in patients with cerebral aneurysm clipping causes transient brain injury, but has no significant effect on the cognitive function of patients.