脳神経外科における術前貯血式自己血輸血

Pre-operative Autologous Blood Collection in Neurosurgical Patients

I．はじめに

　外科手術において輸血は欠かせないものであるが，従来行われてきた同種血輸血には一定の確率で副作用の危険が必ず伴う．このような副作用を防止する手段として自己血輸血が行われる傾向にあるが，脳神経外科領域における自己血輸血に関する報告はまだ少ない。この理由として，脳神経外科手術は緊急手術が多く術前貯血式自己血輸血の導入が困難なことや自己血輸血に対する意識の問題などがあげられよう．われわれは1992年6月から貯血式自己血輸血を導入しており，今回その結果の検討を行った．さらにMSBOS（maximum surgical blood order schedule：最大手術血液準備量）設定のため当科における手術例の術中出血量，輸血量の検討も行い，術前貯血量の設定についても検討したので併せて報告する．

Homologous transfusion has been known to cause viral infections and other comphcations.Recently,auto-logous transfusion has been adopted widely as a safer and more effective procedure to prevent these com-plications.

The authors report the experiences of 29 patients who had been operated on after preparation of auto-logous blood,Furthermore,the authors report a study concerning maximum surgical blood order schedule (MSBOS) of these operations. 212 patients operated on between January, 1991 and June, 1993 were used for this study of MSBOS. Although intraoperative transfusion was performed on 14 of 29 patients, the need for homologous transfu-sion was avoided in 12 of these 14 patients by the use of autologous blood. The frequency of homologous transfusion was reduced significantly after the introduc-tion of pre-operative autologous blood collection in our clinic. The patients' value of hemoglobin fell after the collection of blood but these levels were not so serious-ly low as to impede the performance of operations. 212 cases of operated patients were divided according to the operative methods and diagnosis for calculation of MSBOS. The results were as follows: Craniotomy and removal of glioma 5u, meningioma 11u, neurinoma 7u, AVM 5u, transsphenoidal surgery 3u, Moyamoya dis-ease 2u and V-P or S-P shunt Ou.

Pre-operative autologous blood collection is easy to achieve for scheduled neurosurgical operations, and autologous transfusion is a beneficial procedure which should be used more widely.