Clinical Study On The Effect Of Blood Transfusion On Short-term Prognosis In Moyamoya Disease During Revascularization Phase

Objective:To observe the effect of infusion of suspended red blood cells on the short-term prognosis of MMD patients with different levels of hemoglobin in elective superficial temporal artery-middle cerebral artery bypass.And to evaluate the brain protection effect of suspended red blood cell transfusion in patients with MMD during revascularization.Method:Collected 110 cases of MMD patients undergoing elective STA-MCA bypass surgery in the Fifth Affiliated Hospital of Zhengzhou University from September 2017 to September 2020.Among them,22 cases failed to undergo bypass surgery due to poor vascular conditions of the patients.There are a total of 88 standard MMD patients.According to whether the MMD patients are associated with anemia before the operation,the enrolled patients are divided into group A（Hb>120g/L）and group B（Hb<120g/L）according to the Hb concentration.Intervention will be carried out within the group.Measures,divide the A component into A1 group（red blood cell group）,A2 group（plasma group）,A3 group（crystal group）,A4 group（colloid group）,and B component into B1 group（red blood cell group）,B2 group（plasma group）Group),group B3（crystal group）,group B4（colloid group）.Among them,there were 44 cases in group A,11 cases in each of A1～A4,44 cases in group B,and 11 cases in each group B1～B4;patients in groups A1 and B1 were infused with 2u suspended red blood cells when the dura was cut,and patients in groups A2 and B2 were cut Infusion of 400ml plasma when the dura is opened,patients in groups A3 and B3 receive 400ml of crystalloid solution when the dura is cut（the crystal solution uses compound sodium chloride injection）,patients in groups A4 and B4 receive 400ml when the dura is cut Colloidal fluid（the colloidal fluid uses hydroxy ethyl starch）;and the blood transfusion is infused within 30 minutes.Select preoperative（T0）,pre-bypass transplantation（T1）,blood transfusion for 5 minutes（T2）,awake extubation for 30 minutes（T3）,postoperative day 3（T4）,postoperative day 7（T5）as observation time point.Use Doppler ultrasound to measure the maximum velocity（Vmax）and minimum velocity（Vmin）of the blood flow of the frontal or parietal branch of the superficial temporal artery（STA）on the affected side at T1,T3～T5.,Mean velocity（Vm）,Resistance index（RI）,Inside diameter（ID）;monitor juglar bulb venous oxygen saturation（SjvO2）at T1～T5),S-100 β protein,lactic acid（Lactic,lac）,hematocrit（HCT）,hemoglobin（Hb）,and record the patient’s mean arterial pressure（MAP）at T1～T3,center Central venous pressure（CVP）,heart rate（HR）;3d and 7d postoperatively,the neurological function of the patients was evaluated by the modified mRS score,and compared with that before the operation;the operation time and vascular anastomosis time of all patients in the group were recorded,The amount of input and output（except for interventional blood transfusion）.Result:（1）Ultrasonic measurement of STA branch blood flow indexes:The STA branch blood flow indexes（Vmax,Vm,Vmin,ID and RI）of group A and B are different at T1,T3～T5（P<0.05）,compared with T1,Vmax,Vm,Vmin,ID increased,and RI decreased at T3～T5（P<0.05）.（2）Hemodynamic indicators:①There were differences in MAP,HR and CVP at T1～T3 in group A（F values were 10.756,5.591 and 73.899,P values were 0.000,0.005 and 0.000 respectively）.Compared with T1 time point,CVP and MAP were higher at T2 and T3,and HR at T2 was lower（P<0.05）;a pairwise comparison between group A showed a difference in MAP（P<0.05）.Compared with group A1,A2～A4 The MAP of the group was lower（P<0.05）.②The difference in HR and CVP at T1～T3 in group B was statistically significant（F values were 5.710 and 45.391,P values were 0.005 and 0.000,respectively）.Compared with T1,CVP was higher at T2 and T3,and HR at T3 High（P<0.05）;Comparison between groups in group B showed a difference in MAP（F=5.801,P=0.002）;compared with group B1,group B2-B4 had low MAP（P<0.05）;③group A and group B There was no significant difference in MAP,CVP and HR at T1～T3（P>0.05）.（3）Biochemical indicators:①There were differences in SjvO2,S100β protein,Lac,HCT and Hb at T1～T5 in the A1～A4 group（P<0.05）.Compared with T1,SjvO2 increased at T2-T5,and S100β at T4～T5.Protein decreased（P<0.05）.Compared with T2,SjvO2 increased at T3～T5,and S 100β protein decreased at T4～T5（P<0.05）;there were differences in SjvO2,S100β protein,HCT and Hb between group A（P<0.05）.Compared with the A2-A4 group,the SjvO2 in the A1 group was higher and the S100β protein was lower（P<0.05）.②There were differences in SjvO2,S100β protein and Hb between T1 and T5 in the B1～B4 group（P<0.05）.Compared with T1,SjvO2 increased and S100β protein decreased at T3～T5,and T2～T5.Hb increased,and the difference was statistically significant（P<0.05）;SjvO2,S100βprotein and Hb were different between group B（P<0.05）.Pairwise comparison was performed.Compared with group B2～B4,group B1 had higher SjvO2,S100β protein was low,Hb was high,the difference was statistically significant（P<0.05）.③There is a difference in SjvO2 at T1～T5 in the A1～A4 and B1～B4 groups（P<0.05）,and there is a difference in S100β protein（P<0.05）;compared with the B1～B4 group,the SjvO2 in the A1～A4 group is higher,and the difference is Statistical significance（P<0.05）;Compared with group B2,group A2 had lower S100β protein,and the difference was statistically significant（P<0.05）.（4）Nerve function evaluation:①There are differences in mRS at T0,T4 and T5 in the A1～A4,B1～34 groups（P<0.05）.Compared with T0,the mRS at T4 and T5 is significantly reduced,and the difference is statistically significant.Clinical significance（P<0.05）;②The neurological prognosis of each group after blood transfusion intervention measures was different,but the difference was not statistically significant（χ2=10.800,P=0.967）.Conclusion:During revascularization,appropriate red blood cell infusion can improve the cerebral oxygen supply in MMD patients and prevent postoperative cerebral ischemia and hypoxia injury,but the difference was not statistically significant.