Schaller R T, Schaller J, Morgan A, Furman E B
Am J Surg. 1983 Jul;146(1):79-84. doi: 10.1016/0002-9610(83)90263-5.
Since 1974, 25 children had 27 major cancer operations with the aid of hemodilution anesthesia. This includes operations for Wilms' tumors, liver tumors, adrenal tumors, pancreatic tumors, ovarian tumors, and resection of metastatic thoracoabdominal tumors. With the use of this method, operative blood loss has been greatly reduced and operative technique improved. At the beginning of surgery, whole blood is removed from the patient and replaced with three times the volume of a balanced electrolyte solution to maintain intravascular volume. After the time of significant blood loss has ceased, the patient's own blood is returned and diuresis stimulated with furosimide to remove the infused electrolyte solution. Hypothermia, allowing the temperature to drift down to just below 32 degrees C, helps protect vital organs against hypoxia and arterial hypotension to a mean of 50 torr systolic pressure is well tolerated and further reduces blood loss. Adequate tissue oxygenation can be maintained safely during hemodilution to a hematocrit value of 14 percent. Use of bank blood transfusion was necessary in only 6 of 25 patients. It was given when the calculated postoperative hematocrit value would be less than 30 percent. The diluted blood lost during surgery has a low red blood cell volume per milliliter and each milliliter lost depletes the total red blood cell volume by a lesser amount. Also, the ease and speed of surgery may be facilitated by the nearly bloodless operative field. Provided respiratory support is maintained, these children showed only minor clinical effects from this large fluid infusion. The majority of patients who are Jehovah's Witnesses accept this technique with the modification that we keep the blood moving and in direct contact with the patient's vascular system. Carefully planned and meticulously applied short-term hemodilution anesthesia provides a safe method for minimizing operative blood loss and reduces the difficulty of major cancer surgery in children.
自1974年以来，25名儿童在血液稀释麻醉的辅助下接受了27次大型癌症手术。这包括肾母细胞瘤、肝肿瘤、肾上腺肿瘤、胰腺肿瘤、卵巢肿瘤的手术，以及转移性胸腹肿瘤的切除术。通过使用这种方法，术中失血已大大减少，手术技术也得到了改进。手术开始时，从患者体内抽出全血，并用三倍体积的平衡电解质溶液替代，以维持血管内容量。在大量失血停止后，将患者自身的血液回输，并使用呋塞米刺激利尿，以排出输注的电解质溶液。体温降低，使温度降至略低于32摄氏度，有助于保护重要器官免受缺氧影响，并且收缩压平均为50托的动脉低血压能被很好地耐受，还能进一步减少失血。在血液稀释至血细胞比容值为14%的过程中，可以安全地维持足够的组织氧合。25名患者中只有6名需要使用库血输血。当计算出的术后血细胞比容值低于30%时才进行输血。手术中流失的稀释血液每毫升的红细胞体积较低，每流失一毫升所消耗的总红细胞体积也较少。此外，几乎无血的手术视野可能有助于提高手术的 ease 和 speed（此处原文ease和speed含义不明确，暂保留英文）。只要维持呼吸支持，这些儿童在大量液体输注后仅表现出轻微的临床影响。大多数耶和华见证会的患者接受了这种技术，但有所修改，即我们保持血液流动并使其与患者的血管系统直接接触。精心规划并严格应用的短期血液稀释麻醉为最大限度减少术中失血提供了一种安全方法，并降低了儿童大型癌症手术的难度。
