小児無輸血開心術の希釈安全限界に関するS-100β蛋白による検討
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The safty limit of hemodilution in open heart surgery is not clear. S-100β protein is a specific protein of the central nervous system. The aim of this study was to investigate the safty limit of hemodilution during extracorporeal circulation (ECC) of the brain by measuring serum S-100(3 protein level. Twenty-two patients (3.3 ± 4.0 y. o., 16.5 ± 11.5 kg, 14 with ventricular septal defect (VSD), 3 atrial septal defect (ASD), 2 ASD with pulmonary stenosis, 2 tetralogy of Fallot, 1 partial endocardial cushion defect) underwent corrective open heart surgery without homologous blood transfusion (N group). One patient with VSD with a minimum hematocrit of 9.6% had a convulsion after surgery. Eleven patients (3.9 ± 4.5 y. o., 15.9 ± 11.2 kg, 4 tetralogy of Fallot, 1 transposition of the great arteries, 1 double outlet right ventricle, 1 tricuspid atresia, 1 corrected transposition of the great arteries, 1 prosthetic valve malfunction, 1 myxoma, 1 Bland-White-Garland syndrome) underwent corrective open heart surgery with blood priming of ECC and postoperative homologous blood transfusion without symptomatic neurological complications (B group). Serum S-100β level was measured by radioimmunoassay before ECC, at the end of ECC, and 6, 12, and 18 hours after ECC. The minimum hematocrit during ECC was significantly lower in N group than B group (Ht: 17.7 ± 4.9 vs 29.9 ± 5.2% ; p<0.01). Duration of ECC (51.4 ± 21.1 vs 84.1 ± 31.1 min, p<0.01) and aortic cross clamp time (84.3 ± 32.7 vs 150 ± 44.2 min, p<0.01) were shorter in N group than B group. There was no significant difference in S-100β level at any point between the two groups, but the VSD case with a convulsion showed the highest value of S-100 at every point after ECC in both groups (5.76, 4.87, 4.30, 5.99 μg/L) . There was no correlation between S-100β level and age, duration of ECC and aortic cross clamp time in both groups. S-100β level at 6, 12, and 18 hours after ECC was significantly correlated with minimum hematocrit in only N group (6 h: Y=6.3-1.9logX, r=0.55, p<0.01, 12 h: Y=5.9-1.9logX, r=0.60, p<0.01, 18 h: Y=9.8-3.2logX, r=0.65, p<0.01). The maximum S-100β level at 6,12, and 18 hours after ECC in B group was 0.98, 0.67, 0.98 μg/L. The safty limit of minimum hematocrit, which was obtained using correlational equations at each time, was 16.4, 15.6, 15.8 (15.9 ± 0.4) %. It was concluded that serum S-100β is a simple and useful marker of brain injury and the safty limit of minimum hematocrit is estimated as being 15.9 ± 0.4 % in pediatric open heart surgery without homologous blood transfusion.
- 東京女子医科大学の論文
- 2000-11-25
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