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整形外科手術患者における大量自己血漿の術前貯血と返血

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概要 Background : Intraoperative washed autologous transfusion of the scavenged blood can reduce the deterioration of anemia, even during the operation with a comparatively large blood loss. On the other h...and, plasma level can not be collected by this system. The preoperative donation and perioperative retransfusion of autologous plasma may reduce the plasma dilution. Purpose : The influence of a large volume plasma predonation and perioperative retransfusion on the plasma protein level was investigated. Methods : Thirteen patients (63.2 ±13.2 yr, 70.3 ±12.1 kg) were examined regarding their serum protein (SP), IgG, coagulation systems, colloid osmotic pressure (COP), blood cell count before, just after, 2 h after and 7 days after the donation of 900 ml plasma by plasmapheresis with a simultaneous volume replacement. Twenty surgical patients (52.8 ± 17.3 yr, 72.6 ± 16.6 kg, the mean predonated autologous plasma : 2100 ml) with intra- and postoperative retransfusion of autologous plasma were examined perioperatively for SP, IgG, coagulation systems and COP. These parameters were compared with that of the predonated plasma. Results : All data including SP, coagulation and COP, with the exception of IgG, completely recovered within 7 days after preoperative plasmapheresis. Perioperatively, autologous washed blood transfusion system was used. The retransfused volume of autologous predonated plasma was 1740 ml on average. Although about 4 l of blood on average was lost perioperatively, only one patient out of 20 patients had to be administered homologous red blood cell transfusion. The levels of most parameters, except for COP, constantly recovered in accordance with the autologous plasma transfusion. Differences in the patterns of improvement were also observed between the parameters. Conclusion : A 900 ml plasma predonation can therefore be safely performed with an interval of not less than a week between the last donation and the operation. Autologous plasma retransfusion is thus considered to improve the protein levels.
[背景]術中,回収式自己血輸血法により赤血球成分を,術前貯血により血漿成分を補うことで,比較的大量出血の手術にも同種血を用いずに管理できるが,貯血時および周術期の血漿成分値の推移は明らかではない.[目的]比較的大量の自己血漿を術前に貯血し,周術期に返血することが血漿蛋白に及ぼす影響を検討した.[方法]13人(年齢63.2± 13.2歳,体重70.3± 12.1kg)の術前患者から輸液を同時にしながら成分分離装置を用いて900ml の血漿を採取したときの血漿蛋白,IgG,凝固系,膠質浸透圧,血算の推移を血漿採取前,採取後2時間後,7日後で調べた.20人(年齢52.8 ± 17.3 歳,体重72.6 ± 16.6kg,平均術前採取血漿2100ml)の整形外科手術患者で術中・術後に術前貯血の自己血漿を返血したときの血漿蛋白,IgG,凝固系,膠質浸透圧,血算の推移を経時的に調べた.これらの項目について採取血漿の値と比較した.[結果]IgG 以外の血漿蛋白,凝固系,膠質浸透圧の検査値は血漿採取7日後には元の値に回復していた.周術期に回収式自己血輸血を用いた.返血した自己血漿の平均値は1740ml で,平均出血量は4l であった.20 症例中1症例で同種血輸血を要した.自己血漿返血に応じて,膠質浸透圧以外のほとんどの項目で検査値は改善した.項目間で血漿返血による検査値の回復過程に相違が認められた.[結論]900ml の術前血漿採取は手術までの期間を1週間以上あければ安全に施行できる.自己血漿の返血により周術期の血漿蛋白値は改善される.
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登録日 2009.04.22
更新日 2017.09.08