烟雾病血运重建期间输血指征对患者近期预后的影响

Effect of blood transfusion indication on the short-term prognosis of patients with moyamoya disease during revascularization

摘要:

目的 探讨烟雾病血运重建期间优化输血指征对患者近期预后的影响。方法 选取该院神经外科择期行颅内外血管搭桥术78例，最终顺利实施搭桥54例。根据血红蛋白（Hb）水平以及输血与否分为A组（Hb 60~120 g/L，输血），B组（Hb>120 g/L，输血），C组（Hb>120 g/L，不输血）。选取旁路移植前（T1）、清醒拔管30 min（T2）、术后第3天（T3）、术后第7天（T4）为观察点。结果 ①T1~T3时点3组颞浅动脉（STA）主干血流最大速度（Vmax）、最小速度（Vmin）、平均速度（Vm）、阻力指数（RI）及内径（ID）有差别（F值分别为10.877、16.396、19.723、9.683及16.348，P值均为0.000）；②3组间比较，Vmin有差别（F =3.237， P =0.047）、RI有差别（F =3.818， P =0.029），但组间两两比较，无差异（P >0.05）；③3组Vmax、Vmin、Vm、RI及ID变化趋势无差别（均P >0.05）；④与T1时点相比，3组患者T4时点颈静脉球部血氧饱和度（SjvO₂）增高（P <0.05），血清S100β蛋白含量降低（P <0.05）；⑤3组T1、T4时点HCT、Hb均有差异（P <0.05）。T4时点B、C组患者HCT、Hb较T1时点降低（P <0.05）；T4时点A、B组之间相比，B组患者HCT、Hb增高（P <0.05）；T4时点B、C组之间相比，C组患者HCT、Hb增高（P <0.05）。结论 烟雾病合并贫血患者血运重建期间，输血治疗对提高脑部血流量和改善脑氧供有促进作用；未合并贫血患者其输血指征取决于烟雾病病理解剖所致脑缺血损害程度。国际神经病学神经外科学杂志, 2021, 48(1): 32-36］

Abstract:

Objective To investigate the effect of optimizing blood transfusion indication during revascularization on the short-term prognosis of patients with moyamoya disease.Methods A total of 78 patients who underwent elective intracranial and extracranial vascular bypass in Department of Neurosurgery were enrolled， among whom 54 underwent successful vascular bypass. According to hemoglobin （Hb） level and whether blood transfusion was performed， these patients were divided into group A （Hb 60-120 g/L， blood transfusion）， group B （Hb >120 g/L， blood transfusion）， and group C （Hb >120 g/L， no blood transfusion）. Observation was performed before bypass transplantation （T1）， at 30 minutes after recovery of consciousness and extubation （T2）， on day 3 after surgery （T3）， and on day 7 after surgery （T4）.Results ①There were statistically significant differences in superficial temporal artery（STA） blood flow indexes which were Vmax， Vmin， VM， RI and ID between the three groups at T1-T3（P <0.05）；②There were statistically significant differences in Vmin (F =3.237, P =0.047) and RI (F =3.818, P =0.029) among the three groups， but no statistically significant differences in pairwise comparison among the three groups (P > 0.05); ③There was no significant difference in Vmax， Vmin， VM， RI and ID among the three groups (all P > 0.05);④Compared with T1， SjvO₂ of jugular bulb increased at T4 in three groups (P < 0.05), and S100 β protein decreased (P < 0.05);⑤There were significant differences in Hct and Hb at T1 and T4 among the three groups (P < 0.05); HCT and Hb in group B and C at T4 were lower than those at T1 (P < 0.05); Compared with group A and B at T4， HCT and Hb in group B were increased (P < 0.05); Compared with group B and C at T4， HCT and Hb in group C were higher (P < 0.05).Conclusions For moyamoya disease patients with anemia during revascularization， blood transfusion therapy can improve cerebral blood flow and cerebral oxygen supply， and for moyamoya disease patients without anemia， blood transfusion indication depends on the degree of cerebral ischemia caused by moyamoya disease.Journal of International Neurology and Neurosurgery, 2021, 48(1): 32-36］