Division of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Childrens Hospital, Cape Town, South Africa.
Pediatr Crit Care Med. 2010 May;11(3):325-31. doi: 10.1097/PCC.0b013e3181b80a8e.
The indications for blood transfusion in traumatic brain injury are controversial. In particular, little is known about the effect of blood transfusion in childhood traumatic brain injury. This study aimed to examine the influence of blood transfusion on brain tissue oxygen tension in children with severe traumatic brain injury.
A retrospective analysis of a prospective observational database of children with severe traumatic brain injury who received brain tissue oxygen tension monitoring and a blood transfusion.
University-affiliated pediatric hospital.
Children with severe traumatic brain injury and blood transfusion.
None.
Brain tissue oxygen tension was measured in normal-appearing white matter with a commercially available polarographic Clarke-type electrode. Brain tissue oxygen tension values after blood transfusion were compared with pre-transfusion values in hemodynamically stable patients. Limited interventions were allowed during the studied period. Brain tissue oxygen tension values were examined for early (1-4 hrs) and late (24 hrs) changes after blood transfusion, controlling for multiple clinical and physiologic variables with regression techniques. Further comparison was made with matched non-transfused controls to examine the influence of time after injury. Nineteen blood transfusions in 17 patients were evaluated. Brain tissue oxygen tension increased significantly in the early period after blood transfusion (p = .0018; 79% increased, 21% decreased) in comparison with baseline values and matched controls, but the overall changes were small and, in part, influenced by accompanying cerebral perfusion pressure changes. Also, this effect was limited to the early period after blood transfusion and was not significant after 24 hrs. In general, the brain tissue oxygen tension increase was larger in patients with higher baseline brain tissue oxygen tension and lower initial hemoglobin; however, no factors associated with the magnitude of the brain tissue oxygen tension change were significant in multivariate analysis. Increased age of blood did not appear to impair brain tissue oxygen tension changes, but most blood transfusion were <14 days old.
Brain tissue oxygen tension increased transiently in 79% of blood transfusion in pediatric traumatic brain injury patients, and decreased transiently in 21%. Brain tissue oxygen tension returned to baseline within 24 hrs. Reliable predictors of this brain tissue oxygen tension response to blood transfusion, however, remain elusive.
创伤性脑损伤的输血适应证存在争议。特别是，关于儿童创伤性脑损伤输血的影响知之甚少。本研究旨在探讨输血对严重创伤性脑损伤患儿脑组织氧张力的影响。
对接受脑组织氧张力监测和输血的严重创伤性脑损伤患儿的前瞻性观察数据库进行回顾性分析。
大学附属儿科医院。
严重创伤性脑损伤伴输血的患儿。
无。
使用商业上可用的极谱 Clarke 型电极测量正常外观白质中的脑组织氧张力。在血流动力学稳定的患者中，比较输血后与输血前的脑组织氧张力值。在研究期间允许进行有限的干预。使用回归技术控制多个临床和生理变量，检查输血后早期（1-4 小时）和晚期（24 小时）脑组织氧张力的变化。进一步与匹配的未输血对照组进行比较，以检查受伤后时间的影响。对 17 例患者的 19 次输血进行了评估。与基线值和匹配对照组相比，输血后早期脑组织氧张力显著升高（p =.0018；增加 79%，减少 21%），但总体变化较小，部分受伴随的脑灌注压变化的影响。此外，这种影响仅限于输血后早期，24 小时后无统计学意义。一般来说，在基线脑组织氧张力较高和初始血红蛋白较低的患者中，脑组织氧张力的升高幅度较大；然而，在多变量分析中，没有与脑组织氧张力变化幅度相关的因素具有统计学意义。血液的增龄似乎不会损害脑组织氧张力的变化，但大多数输血<14 天。
在 79%的儿童创伤性脑损伤患者的输血中，脑组织氧张力短暂增加，21%的患者的脑组织氧张力短暂降低。脑组织氧张力在 24 小时内恢复到基线。然而，这种脑组织氧张力对输血反应的可靠预测因素仍难以捉摸。
