開心術における術前自己血貯血の検討

Autotransfusion Using a Recombinant Human Erythropoietin in Elective Cardiac Surgery

　待機的開心術27例に対して，遺伝子組換えヒトエリスロポエチン（rHuEPO）を術前投与し，自己血貯血による手術時の同種血輸血を回避する自己血輸血療法を行い，以前の42例と比較検討した．同種血輸血同避率は以前の40.4％から59.3％と有意差はなかったものの改善した．同種血輸血量は1,829mlがrHuEPO投与により769mlと有意差をもって減少し，同種血輸血量改善効果が確認された．対象27例全例にrHuEPOを投与したが，術前貯血が可能であったのは21例，77％で，平均貯血量は659mlであった．現在の無輸血手術率は満足できるものではなく，今後，現在使用している体外循環回路および血液心筋保護供給装置の改善とともに，出血量の削減，貯血量の増加が必要と考えられた。

The purpose of this study was to determine the effects of autologous blood donation before elective cardiac surgery using a recombinant human erythropoietin (rHuEPO). Twenty-seven patients prospectively made preoperative autologous blood donation using rHuEPO (EPO group; n=27) and 42 patients made no preoper-ative autologous blood donation (nonEPO group; n= 42). Only 17 patients in the nonEPO group didn't receive homologous blood (40.4%), meanwhile 16 in the EPO group received transfusion of their own autologous blood (59.3%). There was no significant difference between the groups with respect to intraoperative hemo-globin concentration or hematocrit. In the EPO group, 21 of 27 patients (77.8%) were able to donate preoper-atively. though all patients were given rHuEPO. In these 21 patients, the mean donation blood volume was 659 ml. We conclude that autologous blood donation using a recombinant human ervthropoietin reduces the homologous blood requirements for elective cardiac surgery, and it is expected that further improvement will be made to minimize the volume of the bypass circuit, and that some method will be devised to reduce blood loss during the operation.