口腔外科手術における術中輸血節減に関する研究

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Mobidity of transfusionhepatitis is still increasing in proportion to blood transfusion volume. Therefore, studies on reduction of blood transfusion were conducted at our clinic. Operations were performed under general anesthesia supplemented with local infiltration of local anesthetics containing Epinephrine (10μg/ml). Blood trasfusion was performed in 32 cases among 579 patients. All the cases were adults. For other 547 cases, low molecular weight dextran, Lactated Ringer's solution and 5% glucose were infused instead of blood. Lactated Ringer's solution and 5% glucose were used two to three times as much as low molecular weight dextran. From the evaluation of the present cases, following summaries could be obtained. Bleeding volume (mean, per minute, per Kg) was calculated. In cleft palate cases, the mean of bleeding volume and bleeding volume per one minute was considerably low, however, bleeding volume per Kg of body weight indicated considerably high. As the result of study for blood transfusion, following criteria may be established. Indicative Criterion of Blood Transfusion in Maxillo-facial Surgery. Absolute Indication for Blood Transfusion. Bleeding volume during operation : over 1000g Bleeding volume per Kg : over 15g Bleeding volume per minute : over 8g Comparative Indication for Blood Transfusion. Bleeding volume during operation : 500-1000g Bleeding volume per Kg : 10-15g Bleeding volume per minute : 6-8g In the present study for blood transfusion, absolute indication proved to be in most cases of upper jaw resection and comparative indication in cases of resection of the lower jaw and tongue, and of neck dissection. Quantitative Criterion of Transfusion and Infusion. Volume of Infusion : 40-50% of bleeding volume at most. Volume of Infusion : Plasma Expander : About 1.5 times as volume of blood transfusion. Lactated Ringer's solution and 5% glucose : About 3 times as volume of blood transfusion. This criterion was, however, indicated for the cases under about 2000g (bleeding volume) during operation. Red blood cells, hematocrit, hemoglobin and total serum protein were examined during the postoperative period. Red blood cells, hematocrit, hemoglobin decreased to 80% of the preoperative values and recovering on the 14th postoperative day in almost all adult cases. However, in infants the recovery of these values retarded prominency compaired with adult cases. Total serum protein decreased about 0.8-1.0g/dl immediately after surgery and recovered on the 14th postoperative day in adult. But this tendency to hypoproteinemia was severer also in infants than in adults. As for 547 cases without transfusion, postoperative clinical course of these patients was uneventful and satisfactory.
九州歯科学会の論文
1974-03-31

口腔外科手術における術中輸血節減に関する研究

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