Impact Of Warming Blood Transfusion And Infusion Toward Cerebral Oxygen Metabolism And Cognitive Recovery In The Perioperative Period Of Elderly Knee Replacement

Objective This study aims to observe the impact of the temperature of bloodtransfusion and infusion toward the perioperative cerebral oxygen metabolism and thepostoperative cognitive recovery.Methods This is a prospective, single-blind and controlled clinical study. A total of80elderly inpatients (ASA,Ⅰ-Ⅱ) scheduled for selective unilateral knee arthroplasty undergeneral anesthesia combined with epidural anesthesia were randomly divided into warmingblood transfusion and infusion group (WBI, n=40) and control group (CON, n=40). WBIwere given the infusion of blood and fluid heated to37℃by FMS2000infusion fluid heatingdevice of Belmont production(America). CON group were given the infusion of blood andfluid placed at room temperature (24℃) for15-20min. The changes of MAP, HR,nasopharyngeal temperature, cerebral blood flow of middle cerebral artery, the rate of cerebraloxygen extraction (CERO2), the value of jugular venous bulb lactic acid and jugular venousbulb oxygen saturation(SjvO2) before induction of anesthesia(T0), before bloodtransfusion(T1), immediately after blood transfusion(T2),30min after blood transfusion(T3),1h after blood transfusion(T4),2h after blood transfusion(T5) were monitered and recordedrespectively. The quality of overall recovery and cognitive rencovery were assessed by PQRSduring15min after extubation,40min after extubation,1d after operation,3d after operation.Results (1) There were no significant differences in age, sex, height, weight, operationtime, extubation time, tourniquet time, blood loss, blood transfusion, or preoperative PQRS baseline value between the two groups(P﹥0.05).(2) There were no significant differences inMAP, HR between the two groups.(3) Compared with T1, the two groups of patients showeda significant decrease in nasopharyngeal temperature at each time point and exist a significantdifference between two groups (P﹤0.01).(4) Compared with T1, the two groups of patientsshowed a obvious decrease in Vs at T2, T3(P﹤0.05, P﹤0.01) and there were no significantdifferences between two groups (P﹥0.05).(5)Compared with T1, the CON group of patientsshowed a significant increase in RI at T2(P﹤0.01) and there were no significant differencesbetween two groups (P﹥0.05).(6) Compared with T1, the two groups of patients showed aobvious increase in CERO2at T3(P﹤0.01) and there were no significant differences betweentwo groups (P﹥0.05).(7) Compared with T1, the two groups of patients showed a obviousincrease in Lac at T2, T3, T4(P﹤0.05) and there were no significant differences between twogroups (P﹥0.05).(8) Compared with T1, the two groups of patients showed a decrease inSjvO2at T3(P﹤0.01) and there were no significant differences between two groups (P﹥0.05).(9) The two groups of patients overall and cognitive occured different degrees of poorrecovery during15min after extubation,40min after extubation,1d after operation,3d afteroperation and there were no significant differences between two groups (P﹥0.05).Conclusion The WBI can significantly reduce the occurrence of the perioperativehypothermia, while it has no significant effect toward cerebral oxygen metabolism,postoperative overall recovery, and recovery of cognitive function.