Yoda M, Nonoyama M, Shimakura T, Morishita A, Takasaki T
Department of Cardiovascular Surgery, Fukuyama Circulation Hospital, Fukuyama, Japan.
Kyobu Geka. 2001 Mar;54(3):203-6.
During the cardiovascular surgeries in elderly people, only a few cases can avoid the homologous blood transfusion, because of their preoperative anemic tendency and low hemopoietic abilities. We examined the capability to avoid the homologous blood transfusion in over 75 year old patients by the preoperative autologous blood collection. Sixty-six patients underwent scheduled cardiovascular surgery between January 1996 and December 1999. The groups were divided into three categories of preoperatively collected autologous blood amounts: high-amount (800-1,200 ml), medium-amount (200-800 ml), and low-amount (0 ml). Each group was divided into two subgroups in according to the use of cardiopulmonary bypass (CPB). There were no differences among the each group in age, body weight, or preoperative and postoperative day-7 hematocrit values.
Only 21.2% of patients could donate the expected blood amounts preoperatively. Mean volume was 641 ml. In groups used CPB, no patient was transfused homologous blood in high-amount group. On the contrary, 100% patients were donated in medium and low amount groups. In groups operated without CPB, homologous blood transfusion was required 14.3% in high-amount group, 25.0% in medium-amount group, and 83.3% in low-amount group.
It seems that predonation of more than 800 ml may be sufficient to avoid the homologous blood transfusion in using CPB operation and more than 400 ml in non using CPB operation.
在老年患者的心血管手术中,由于术前贫血倾向和造血能力低下,只有少数病例能够避免同种异体输血。我们通过术前自体采血来检验75岁以上患者避免同种异体输血的能力。1996年1月至1999年12月期间,66例患者接受了择期心血管手术。这些患者根据术前采集的自体血量分为三类:高量组(800 - 1200毫升)、中量组(200 - 800毫升)和低量组(0毫升)。每组再根据是否使用体外循环(CPB)分为两个亚组。各组在年龄、体重或术前及术后第7天的血细胞比容值方面均无差异。
只有21.2%的患者术前能够献出预期血量。平均血量为641毫升。在使用CPB的组中,高量组没有患者接受同种异体输血。相反,中量组和低量组的患者全部接受了输血。在未使用CPB的手术组中,高量组有14.3%的患者需要进行同种异体输血,中量组为25.0%,低量组为83.3%。
对于使用CPB的手术,术前预存800毫升以上的自体血似乎足以避免同种异体输血;对于未使用CPB的手术,400毫升以上可能就足够了。