Yuyama R, Mishima K, Fujimaki T, Suzuki I, Sasaki T, Ueno H, Shibata Y, Kirino T
Department of Neurosurgery, Faculty of Medicine, University of Tokyo.
No Shinkei Geka. 1998 Aug;26(8):685-90.
Clinical experience of autologous blood preservation on 83 patients and transfusion on 43 patients were reported. When drawing blood, 14 patients whose hemoglobin level was below 13 g/dl (body weight < 70 kg) or 14 g/dl (body weight > 70 kg) received subcutaneous recombinant human erythropoietin injection (s.c.) to facilitate erythropoiesis, according to the internal standard protocol. Hemoglobin levels of all the patients recovered to more than 10 g/dl by the time they were admitted to the hospital, which value would not interfere with general neurosurgical procedures. The injection of erythropoietin did not cause any side effects. Autologous blood transfusion was performed in 43 patients but, in 3 patients, additional homologous transfusion was required because of excessive bleeding. Except in cases with meningioma, postoperative hemoglobin values were identical with preoperative values, indicating that autologous blood transfusion was enough to replace intraoperative blood loss. Autologous fibrin glue was applied in 74 patients. In 70 cases including 55 with skull base surgery, the glue was applied to ensure dural closure. The incidence of cerebrospinal fluid leakage was 16.4% (5 patients) in skull base surgery. This incidence was identical to or less than that in previous reports. The glue was also effective in transposing and fixing offending vessels in 4 cases which received microvascular decompression. As a conclusion, procedures for autologous blood preservation and transfusion were safely performed in neurosurgical cases. Review of the literature was also presented to discuss the advantages and problems to be solved in the future.
报告了83例患者自体血保存及43例患者输血的临床经验。采血时，根据内部标准方案，14例血红蛋白水平低于13 g/dl（体重<70 kg）或14 g/dl（体重>70 kg）的患者接受皮下重组人促红细胞生成素注射以促进红细胞生成。所有患者入院时血红蛋白水平均恢复至10 g/dl以上，该值不会干扰一般神经外科手术。促红细胞生成素注射未引起任何副作用。43例患者进行了自体输血，但3例因出血过多需要额外输注异体血。除脑膜瘤病例外，术后血红蛋白值与术前值相同，表明自体输血足以弥补术中失血。74例患者应用了自体纤维蛋白胶。在70例包括55例颅底手术的病例中，应用该胶水以确保硬脑膜闭合。颅底手术中脑脊液漏的发生率为16.4%（5例）。该发生率与既往报道相同或更低。该胶水在4例接受微血管减压的病例中对移位和固定病变血管也有效。结论是，自体血保存和输血程序在神经外科病例中安全实施。还对文献进行了综述，以讨论未来的优势和有待解决的问题。
