開心術における赤血球濃厚液単独使用の有用性に関する検討 新鮮血使用例との比較

Abstract

We have tried to save the blood in open-heart surgery, then concentrated the diluted blood remained in the reservoir after cardiopulmonary bypass (CPB), and transfused it to the patients through venous line. Also we have primed extracorporeal circuit with concentrated red blood cells. In this study, we compare the results of this method with it produced through transfusion and the priming of fresh whole blood and fresh frozen plasma, and investigate the effectiveness and safety in the usage of concentrated red blood cells as the priming fluid. (Material and Method) From January, 1984 to December, 1987, 84 adult patients underwent coronary artery bypass surgery. We classified them into two groups, depending on their priming fluid for extracorporeal circuit, fresh whole blood or concentrated red blood cells. In group I consisted of 41 patients, fresh whole blood was used for the priming and in group II, consisted of 43 patients, in which concentrated red blood cells were applied and the blood components remained in the reservoir after weaning from CPB were concentrated and returned to patients. In these two groups, we compare the hemodynamic functions and the hematorogical data and also evaluate the safety through the usage of concentrated red blood cells in open-heart surgery. (Results) The components and average amount of blood used in group I were 11.6±5.5 units of fresh whole blood and 8.2±5.9 units of fresh frozen plasma. In group II, they were 6.1±3.0 units of concentrated red blood cells and almost no fresh whole blood or fresh frozen plasma were required. The diluted volume of 1, 315±320ml in the CPB reservoir was concentrated to 620±275ml of blood components and transfused. The values of hemoglobin and hematocrit were significantly higher in group I than these in group II, but there were no significant differences in cardiac index, pulmonary capillary wedge pressure and stroke work index among hemodynamic functions. The incidence of post-transfusion hepatitis was 3/41(7.3%) in group I, while zero in group II. (Conclusion) Concentrated red blood cells could be applied safely as the priming fluid for CPB in open-heart-surgery, and are clearly effective in prevention of post-transfusion hepatitis. These results indicate that this method has a big advantage.