Effects Of Intraoperative Restrictive Transfusion As Acute Hypervolemic Hemodilutionon On Cerebral Oxygen Metabolism And Energy Metabolism In Aged Neurosurgical Patients

Objective:To observe the effects of restrictive transfusion as acute hypervolemic hemodilution(AHHD)on cerebral oxygen metabolism and energy metabolism in aged neurosurgical patients.Methods:Forty aged patients,aged 60-75 years old,American Society of Anesthesiologists(ASA)grade ?-?,undergoing neurosurgery under general anesthesia were enrolled in this study.All patients were subjected to AHHD with 10 mL/kg hydroxyethyl starch solution at a rate of 20-30 mL/min after induction.The patients were randomly allocated to two groups:empirical transfusion group(group A:blood transfusion indication:Hb<100 g/L)and restrictive transfusion group(group B:blood transfusion indication:Hb<80 g/L).There were 20 cases in each group.Arterial and bulb of jugular venous blood samples were collected after induction(T1),before blood transfusion(T2)and at the end of surgery(T3)for blood gas analysis.Jugular bulb oxygen saturation(Sjv02),blood glucose(Glu)and plasma lactic acid(Lac)levels were measured to cerebral oxygen extraction rate(CER02),calculate cerebral oxygen consumption(Ca-jvO2),glucose extraction rate(CERGlu)and difference between bulb of jugular vein and artery lactic acid(Djv-aLac).Results:CVP at T2 and T3 was significantly higher than that at T1(all P<0.05),while Hb level at T2 and T3 was significantly lower than that at T1 in both groups(all P<0.05).Hb level at T3 was significantly higher than that at T2 in the empirical transfusion group(P<0.05).Hb level in the restrictive transfusion group was significantly lower than that in the empirical transfusion group at T2 and T3(all P<0.05).Total blood transfusion volume and patient proportion of intraoperative blood transfusion of the restrictive transfusion group were significantly lower than those of the empirical transfusion group(all P<0.05).In both groups,compared with the parameters at T1,SjvO2,Laca and Lacjv at T2 and T3 and Glua and Glujv at T3 were significantly increased(all P<0.05),while CaO2,CjvO2 and Ca-jv,O2 at T2 and T3 and CERO2 at T3 were significantly decreased(all P<0.05).Conclusion:For aged neurosurgical patients without severe organic diseases or high intracranial pressure,intraoperative restrictive transfusion as AHHD can retain cerebral oxygen supply-demand balance and has no adverse effects on cerebral energy metabolism;Can reduce the amount of blood transfusion of blood transfusion in the operation strategy,effectively save blood resources;at least restrictive transfusion strategies as safe and effective as open transfusion strategies;Restrictive transfusion has more advantages still needs to be further confirmed for clinical prognosis of postoperative cognitive function.