Abstract:

Objective　To explore the effects of restrictive and liberal blood transfusion on the prognosis in elderly patients undergoing different elective surgeries. Methods　A total of 80 elderly patients undergoing elective surgery in The First Dongguan Affiliated Hospital of Guangdong Medical University from January 2019 to June 2021 were randomly evenly divided into two groups using computer numbers. There were 26 males and 14 females in the control group, aged (64.82±2.71) years; there were 22 males and 18 females in the observation group, aged (65.67±3.39) years. The patients in the control group were given liberal blood transfusion when hemoglobin (Hb) <100 g/L, while the patients in the observation group were given restrictive blood transfusion when Hb <70 g/L. The safety and efficacy indexes of the two groups were recorded and compared before surgery (T0), at the end of surgery (T1), 1 day after surgery (T2), and 7 days after surgery (T3). t test was used for the measurement data and χ² test was used for the count data. Results　At T0, there were no statistically significant differences in the mean arterial pressure (MAP), heart rate (HR), Hb, international standardized ratio of prothrombin time (PT-INR), and creatinine (Crea) between the two groups (all P>0.05). At T1, T2, and T3, there were no statistically significant differences in the MAP, HR, PT-INR, and Crea between the observation group and the control group (all P>0.05); the Hb levels of the observation group were (81.50±12.17) g/L, (101.60±8.33) g/L, and (117.45±18.23) g/L, which were significantly lower than those of the control group [(109.00±11.23) g/L, (125.33±9.34) g/L, and (136.50±25.55) g/L], with statistically significant differences (all P<0.05). At T0, there were no statistically significant differences in the cerebral arterial blood oxygen content (CaO₂), cerebral oxygen uptake rate (CEO₂), lactic acid (Lac), and Mini-Mental State Examination (MMSE) score between the two groups (all P>0.05). At T1, T2 and T3, there were no statistically significant differences in the CaO₂, CEO₂, and Lac between the observation group and the control group (all P>0.05). At T2 and T3, the MMSE scores in the observation group were (24.04±1.91) points and (27.32±2.14) points, which were significantly higher than those in the control group [(21.81±2.48) points and (23.51±2.31) points], with statistically significant differences (both P<0.05). The blood transfusion volume and incidence of complications in the observation group were (2.08±0.26) U and 5.00% (2/40), respectively, which were lower than those in the control group [(3.17±0.83) U and 15.00% (6/40)], with statistically significant differences (both P<0.05). Conclusion　Restrictive blood transfusion for elderly patients undergoing elective surgery can effectively balance the level of cerebral oxygen metabolism, maintain the stability of circulation, and promote the recovery of cognitive function.

Key words: Restrictive strategy for red blood cell transfusion, Cognitive function, Elective surgery

摘要： 目的　研究限制性输血与开放性输血2种不同输血方式在不同择期手术老年患者中的预后。方法　选取2019年1月至2021年6月广东医科大学附属东莞第一医院各种择期手术老年患者80例，使用电脑数字随机分为两组，各40例。对照组男26例、女14例，年龄（64.82±2.71）岁，为开放性输血，红细胞输注时机为血红蛋白（Hb）<100 g/L；观察组男22例、女18例，年龄（65.67±3.39）岁，为限制性输血，输血时机为Hb<70 g/L。记录并比较手术前（T0）、手术结束时刻（T1）、术后1 d（T2）及术后7 d（T3）两组患者安全性指标及有效性指标。计量资料采用t检验，计数资料采用χ²检验。结果　T0时，两组患者平均动脉压（MAP）、心率（HR）、Hb、凝血酶原时间国际标准化比值（PT-INR）及肌酐（Crea）指标比较，差异均无统计学意义（均P>0.05）；T1、T2、T3时，观察组MAP、HR、PT-INR及Crea与对照组相比，差异均无统计学意义（均P>0.05），而观察组Hb水平为（81.50±12.17）g/L、（101.60±8.33）g/L、（117.45±18.23）g/L，均明显低于对照组（109.00±11.23）g/L、（125.33±9.34）g/L、（136.50±25.55）g/L，差异均有统计学意义（均P<0.05）。T0时，两组患者脑动脉血氧含量（CaO₂）、脑氧摄取率（CEO₂）、乳酸（Lac）及简易智力状态检查量表（MMSE）评分比较，差异均无统计学意义（均P>0.05）；T1、T2、T3时，观察组CaO₂、CEO₂、Lac指标与对照组比较，差异均无统计学意义（均P>0.05）；T2、T3时，观察组MMSE评分为（24.04±1.91）分、（27.32±2.14）分，均明显高于对照组（21.81±2.48）分、（23.51±2.31）分，差异均有统计学意义（均P<0.05）。观察组输血量、并发症发生率分别为（2.08±0.26）U、5.00%（2/40），均低于对照组（3.17±0.83）U、15.00%（6/40），差异均有统计学意义（均P<0.05）。结论　对于老年择期手术患者进行限制性输血，能有效平衡脑氧代谢水平，维持患者循环稳定，并促进认知功能的恢复。

关键词: 限制性输血, 认知功能, 择期手术