頭部外科患者の手術前後の循環血液の性状並びにそれに対する輸血輸液に関する研究

Studies on the pre-and-postoperative changes of the circulating blood and the replacement of blood and fluid in the neurosurgical patients

第1章　緒言

　従来外科の領域に於いて，手術という大なる侵襲をはさんで術前より術後迄，各種の検討を行い^1〜8），輸血輸液の適正量を論じた業績は非常に多いが，頭部外科におけるそれは他の外科領域に比して非常に少ない。

　頭部外科に於いては一般的なる手術侵襲に加うるに，生体の物質代謝の中枢たる脳に対する直接の影響よりしても，生体の受ける態度に特異性の生ずる事は充分に想像せられる所である。この方面に従来より比較的優れた業績の揃つているのは電解質変動の部門であつてCooper^9）10），Wise，^11）Mayerson^12），Wilde^13），Pool^14），Walker^15），Woringer^16），Anthonisen^17），陳^18）等が解析を試みたが，術後血清中のNa^＋，K^＋，Cl^－の濃度と予後の問題では尚意見が一致していない。輸血量と術後の血液像を充分に追及したものは本邦には之を見ず，外国ではSmolik^19）等が術後の血液の性状，循環血液量を測定しているが，他の外科領域のそれ等に比すれば甚だしく淋しい。

　A) The relationship between the blood lossand replaced blood-volume during neurosurgical operations was studied from the anesthetic charts in about 300 cases.

　B) The blood loss during neurosurgery wasestimated by several kinds of methods (dyegravimetric and colorimetric methods) in 30selected neurosurgical cases.

　Chemical examinations were carried outpre-and postoperatively to get an informationabout changes of body fluid, circulating bloodand serum electrolytes in about 80 neurosurgical cases, and then, the replacementwith blood and fluid was discussed.

　1) Few neurosurgical patients were found torequire blood transfusion and fluid infusionpreoperatively.

　2) During neurosurgical procedure with bloodloss of about a thousand cc. blood from130% to 140% of the blood loss estimatedby gray imetric method was necessary to begiven to maintain the blood volume at thepreoperative level.

　3) In all of the neurosurgical patients anemiacharacterized with the progressive depletionof the total red cell volume (estimated byT-1824 dye method) was found at the earlypostoperative period, from immediately afteroperation to the 5th day. The influence ofthe central nervous system to the hemodynamics and hematopoiesis might be consideredone of the causes of the post operativeanemia.

　4) Hypoferremia was found in the postoperativeperiod.

　5) Postoperatively, some of the neurosurgicalpatients were found to show abnormal levelsof serum electrolytes, and clinical manifestations with poor prognosis.