Muthuchellappan R, Shaikh N A, Surve R M, Ganne U R S, Philip M
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru, India.
Department of Anaesthesiology and Critical Care, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
Transfus Med. 2018 Aug;28(4):304-309. doi: 10.1111/tme.12504. Epub 2018 Jan 10.
Although central venous oxygen saturation (ScvO ) is used to decide on red blood cell (RBC) transfusion, whether its improvement is associated with parallel improvement in cerebral oxygenation is not adequately studied. This study looked at changes in regional cerebral tissue oxygen saturation (rSO ) following RBC transfusion in neuro-intensive care unit (ICU) patients.
In this prospective observational pilot study, rSO was measured in adult neuro-ICU patients before RBC transfusion, at the end and at 6, 12, 18 and 24 h after RBC transfusion. rSO measurements were taken using cerebral oximetry on both sides of the hemicraniums. Haemoglobin, central venous pressure, ScvO and temperature were recorded during the study period. Arterial oxygen content, central venous oxygen content and cerebral fractional oxygen extraction were calculated. Mann Whitney U test was used to study the changes in variables at baseline and at 24 h following RBC transfusion. Friedman's test was used to study changes in parameters from baseline to 24 h post-transfusion. A P value of <0·05 was considered to be significant.
The data from 13 subjects were analysed. rSO increased significantly following RBC transfusion on both sides of the brain (P = 0·002, P = 0·007), with a corresponding decrease in cerebral fractional oxygen extraction (P = 0·001, P = 0·007).
RBC transfusion increased rSO significantly on both sides of the brain. As patients' outcomes were not studied, whether this increase in regional cerebral oxygen saturation is beneficial or if it is because of excess DO is still unclear. Further studies are required to clarify this issue.
尽管中心静脉血氧饱和度（ScvO₂）被用于决定红细胞（RBC）输注，但对于其改善是否与脑氧合的同步改善相关，尚未进行充分研究。本研究观察了神经重症监护病房（ICU）患者输注红细胞后局部脑组织氧饱和度（rSO₂）的变化。
在这项前瞻性观察性试点研究中，对成年神经ICU患者在输注红细胞前、输注结束时以及输注后6、12、18和24小时测量rSO₂。使用脑氧饱和度仪在颅骨两侧进行rSO₂测量。在研究期间记录血红蛋白、中心静脉压、ScvO₂和体温。计算动脉血氧含量、中心静脉血氧含量和脑氧摄取分数。采用曼-惠特尼U检验研究输注红细胞前后基线和24小时时变量的变化。采用弗里德曼检验研究输注后从基线到24小时参数的变化。P值<0.05被认为具有统计学意义。
分析了13名受试者的数据。输注红细胞后，双侧大脑的rSO₂显著增加（P = 0.002，P = 0.007），同时脑氧摄取分数相应降低（P = 0.001，P = 0.007）。
输注红细胞显著增加了双侧大脑的rSO₂。由于未研究患者的预后，局部脑氧饱和度的这种增加是否有益，或者是否是由于氧输送过多所致仍不清楚。需要进一步研究来阐明这个问题。
