無輸血開心術に関する研究

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The so-called no-blood transfusion open heart surgery, using non-homologous blood during and after surgery, was performed for the purpose of preventing complications from blood transfusion and economizing on blood, and a study was made on the indications and limit of this technique on pathophysiology of no-blood filling diluted extracorporeal circulation, combined use of hypothermia, the amount of bleeding during and after surgery, postoperative anemia and postoperative clinical course. The subjects were 10 cases of atrial septal closing surgery. 38 valvular surgery cases and 5 A-C bypass surgery cases for a total of 53 cases. The no-blood transfusion open heart surgery could be performed in 83 percent of the cases, that is, atrial septal defect closing operation, 10 cases (100%), open heart mitral commissure incision, 10 cases (91%), mitral valve replacement, 11 cases (73%), aortic valve replacement, 8 cases (89%), mitral valve replacement plus aortic valve replacement, 2 cases (67%) and A-C bypass, 3 cases (60%) . The success of this technique depends heavily on the perfusion time (p<0.01) and the amount of postoperative bleeding (p<0.05) . Noblood transfusion open heart surgery was possible in 28 out of 30 cases (93%) when perfusion time was less than 120 min and in 16 out of 23 cases (70%) with the perfusion time of 120 min or more. The amount of postoperative bleeding in cases of no-blood transfusion was 306+103 ml (mean+S.D.) in atrial septal defect closing surgery and 505±256 ml in valvular surgery and A-C bypass, which was significantly small (p<0.05) compared with that of 907±319 ml in cases of transfusion using homologous blood. The amount of postoperative bleeding was directly proportional to the perfusion time (p<0.01) and inversely proportional to the Ht values in perfusion and blood platelet count immediately after perfusion (p<0.05) . Thus, conditions such as a perfusion time of less than 120 min, highdegree dilution of the Ht value during perfusion being 15-20% and a blood platelet count of 100×103/mm3 are considered to increase the possibility of the no-blood transfusion technique being used in open heart surgery. No-blood filling diluted extracorporeal circulation is very likely to be high-degree dilution. Protection of the myocardium is needed in cases requiring extracorporal circulation for 60 min or longer. Furthermore, the nasopharyngeal temperature and the oxygen consumption during perfusion were directly proportional to the drop in the oxygen transport activity (p<0.01) . Thus, the combined use of hypothermia is considered indispensable. According to a study on water balance during operation and postoperative PaO2 and respiratory index, the water load (p<0.01) and urinary excretion (p<0.01) during operation are higher in the highly diluted group (Ht value 15-20%) compared to that in the moderately diluted group (Ht value 20-28%), suggesting that homeostasis is at work. The respiratory index showed higher values (p<0.05) in the highly diluted group than in the moderately diluted group immediately after perfusion and immediately after operation, which is suggestive of slight extravascular retention. Accordingly, Ht 15% or more is considered safe for dilution of blood. The postoperative minimum Ht value in the no-blood transfusion cases was low, 35.2±2.9% in the ASD group and 30.0±4.8%, in the valvular surgery and A-C bypass groups. But it's influence on the postoperative course of anemia appeared negligible.Not even 1 case had postoperative hepatitis, 1 of the undesirable postoperative complications. Thus, this technique was considered useful in preventing postoperative hepatitis. Judging from the results presented above, no-blood transfusion open heart surgery, though not applicable in all cases, can be used for the majority of cases.
昭和大学・昭和医学会の論文

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道端哲郎
昭和大学医学部外科学教室

無輸血開心術に関する研究

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