Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 191406, USA.
Curr Opin Crit Care. 2013 Apr;19(2):83-91. doi: 10.1097/MCC.0b013e32835eba43.
Anaemia is common among patients in the neurocritical care unit (NCCU) and is thought to exacerbate brain injury. However, the optimal haemoglobin (Hgb) level still remains to be elucidated for traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and acute ischaemic stroke (AIS). This review outlines recent studies about anaemia and the effects of red blood cell transfusion (RBCT) on outcome in TBI, SAH and AIS patients admitted to the NCCU.
Patients with severe SAH, AIS and TBI often develop anaemia and require RBCT. In general critical care, a restrictive RBCT strategy (Hgb ~7 g/dl) is preferable in patients without serious cardiac disease. In severe TBI, AIS and SAH, both anaemia and RBCT may negatively influence clinical outcome. However, the appropriate RBCT trigger remains unclear and there is great variance in how these patients are transfused. There is evidence from PET and microdialysis studies in humans that RBCT can favourably influence brain metabolism and oxygenation. This correction of hypoxia or altered metabolism rather than anaemia may be of greater importance.
Results from general critical care should not be extrapolated to all patients with acute brain injury. Transfusion is not risk free, but RBCT use needs to be considered also in terms of potential benefit.
神经重症监护病房（NCCU）中的患者常伴有贫血，且据认为贫血会加重脑损伤。然而，对于创伤性脑损伤（TBI）、蛛网膜下腔出血（SAH）和急性缺血性脑卒中（AIS），最佳血红蛋白（Hgb）水平仍有待阐明。本文综述了最近关于 NCCU 中 TBI、SAH 和 AIS 患者贫血以及红细胞输血（RBCT）对预后影响的研究。
严重 SAH、AIS 和 TBI 患者常发生贫血并需要 RBCT。在一般重症监护中，对于无严重心脏疾病的患者，采用限制性 RBCT 策略（Hgb~7 g/dl）更为可取。在严重 TBI、AIS 和 SAH 中，贫血和 RBCT 均可能对临床预后产生负面影响。然而，合适的 RBCT 触发因素仍不清楚，这些患者的输血方式差异很大。来自人类正电子发射断层扫描（PET）和微透析研究的证据表明，RBCT 可有利地影响脑代谢和氧合。这种缺氧或代谢改变的纠正可能比贫血更为重要。
不能将一般重症监护的结果推断到所有急性脑损伤患者。输血并非没有风险，但也需要考虑 RBCT 的潜在益处。
