Nakamura Y, Masuda M, Toshima Y, Asou T, Oe M, Kinoshita K, Kawachi Y, Tanaka J, Tokunaga K
Division of Cardiovascular Surgery, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Ann Thorac Surg. 1990 Jun;49(6):973-8. doi: 10.1016/0003-4975(90)90879-b.
Hemoconcentration for the establishment of no-donor blood transfusion in open heart surgery was assessed in regard to both the saving of protein and platelets and the exclusion of free hemoglobin. Two different types of hemoconcentrator were compared: the ultrafilter (group I, 6 patients) and the Cell Saver (group II, 6 patients). The total serum protein level, expressed as the percent recovery of the preoperative value, after hemoconcentration was significantly higher in group I (group I versus group II: total serum protein, 118% versus 87% [p less than 0.05]; fibrinogen, 77% versus 50% [p less than 0.01]; immunoglobulin, 83% versus 60% [p less than 0.01]). The platelets also seemed to be well preserved after hemoconcentration in group I. Although the exclusion of free hemoglobin from plasma was inferior in group I compared with group II, the postoperative plasma free hemoglobin level did not increase in group I. We conclude that use of the Cell Saver in nontransfusion cardiopulmonary bypass might cause a severe depletion of various proteins and that the ultrafilter is both safer and more useful if employed routinely.
在心脏直视手术中，为建立无供体输血而进行血液浓缩时，对蛋白质和血小板的保存以及游离血红蛋白的排除进行了评估。比较了两种不同类型的血液浓缩器：超滤器（第一组，6例患者）和血液回收机（第二组，6例患者）。血液浓缩后，以术前值的恢复百分比表示的总血清蛋白水平在第一组显著更高（第一组与第二组相比：总血清蛋白，118%对87%[p<0.05]；纤维蛋白原，77%对50%[p<0.01]；免疫球蛋白，83%对60%[p<0.01]）。第一组血液浓缩后血小板似乎也保存良好。虽然第一组从血浆中排除游离血红蛋白的效果不如第二组，但第一组术后血浆游离血红蛋白水平没有升高。我们得出结论，在非输血体外循环中使用血液回收机可能会导致各种蛋白质严重消耗，如果常规使用，超滤器更安全、更有用。
