Yoda Masataka, Nonoyama Masaki, Shimakura Tadayuki
Department of Cardiovascular Surgery, Fukuyama Circulation Hospital, 1-26 Sumiyoshi-cho, Fukuyama, Hiroshima 720-0809, Japan.
Surg Today. 2004;34(1):21-3. doi: 10.1007/s00595-003-2641-0.
Preoperative autologous blood donation reduces exposure to homologous blood transfusions in cardiac surgery. The purpose of this study was to ascertain the volume of predonated autologous blood needed to avoid homologous blood transfusion in scheduled off-pump coronary artery bypass grafting (off-pump CABG).
Fifty-six patients underwent scheduled off-pump CABG between January 1999 and December 2000. These patients all donated either 400 ml (group 1, n = 33) or 800 ml (group 2, n = 23) of autologous blood before operation. These patients donated at a rate of 400 ml per week. All patients were given an equal volume of saline solution at the time of autologous donation.
There were no significant differences in the mean age, mean body weight, mean preoperative hematocrit values, mean graft number, or mean volume of intraoperative blood loss between groups 1 and 2. There was a significant difference in the mean postoperative day-7 hematocrit value (33.6% +/- 1.3% vs 39.3% +/- 1.3%, P << 0.05). The rates of avoiding homologous blood transfusion were 63.6% in group 1 and 100% in group 2 ( P << 0.05).
Autologous blood transfusion is effective for reducing the homologous blood requirement. We believe that an 800-ml predonation is sufficient to avoid homologous blood transfusion in scheduled off-pump CABG; furthermore, patients with cardiovascular disease, including severe coronary artery disease, should be administered saline along with the blood donation.
术前自体输血可减少心脏手术中异体输血的暴露。本研究的目的是确定在计划进行的非体外循环冠状动脉搭桥术（off-pump CABG）中避免异体输血所需的预先采集的自体血量。
1999年1月至2000年12月期间，56例患者接受了计划的非体外循环冠状动脉搭桥术。这些患者均在术前捐献了400毫升（第1组，n = 33）或800毫升（第2组，n = 23）的自体血。这些患者以每周400毫升的速率进行捐献。在自体血捐献时，所有患者均接受等量的盐溶液。
第1组和第2组在平均年龄、平均体重、术前平均血细胞比容值、平均移植血管数量或术中平均失血量方面无显著差异。术后第7天的平均血细胞比容值存在显著差异（33.6%±1.3%对39.3%±1.3%，P << 0.05）。第1组避免异体输血的比例为63.6%，第2组为100%（P << 0.05）。
自体输血对于减少异体血需求是有效的。我们认为，800毫升的预先采集量足以避免在计划的非体外循环冠状动脉搭桥术中进行异体输血；此外，患有心血管疾病（包括严重冠状动脉疾病）的患者在献血时应同时输注生理盐水。
