自己血輸血の歴史と脳神経外科

History of Autologous Blood Transfusion in Neurosurgical Operations

I．はじめに

　近年，輸血医療の変貌は著しく，また血液事業をめぐる行政の動きも激しい．前者は医療技術の長足の進歩と疾病構造の変化によるものであり，後者は薬害エイズ事件を発端とする安全性の問題と，少子高齢社会にともなう献血人口の減少をめぐる問題が主体をなす．このための対応の中，輸血用血液の使用量を減少させる方策として，適正使用基準^7）の確立と自己血輸血の応用がある．とくに1997年4月より輸血医療に対するインフォームド・コンセントが保健医療上義務付けられて以来，多くの医療機関で自己血輸血の施行頻度が高まって来た．さらに1997年5月に発生した輸血用血液によるHIV感染第1号の報告が，これに拍車をかけた傾向がうかがえる^11）．

　筆者は自己血輸血の歴史をたどる時，その発端が脳神経外科手術と深い関連を持つことを知り興味を覚えた．現在の自己血輸血の主体は貯血式と呼ばれるものであり，回収式と希釈式が補助的な役割を果たしているが，貯血式自己血輸血の第一例が脳神経外科手術におけるものであり，また回収式の第一例もHarvey Cushingのもとで行われた手術であることを知り，驚きであった．ここにその歴史を紹介し，現在の輸血医療問題との関連についても検討を行いたい．

The first report on predeposit autologous blood transfusion was made in 1921 by F.C. Grant, neuro-surgeon in the University Hospital of Pennsylvania. The patient was a 42-year-old man with cerebellartumor, having a rare blood type for which no donor had been listed up. 500 ml of autologous blood wasobtained, kept in 0.2% sodium citrate solution in a refrigerator and retransfused following a suboccipital ex-ploration. Clinically, no reaction was noted and there was a favorable postoperative course, and 'autotrans-fusion' was evaluated as a life-saving procedure.

In 1925, L.E. Davis and H.Cushing reported the first case of intraoperative autotransfusion (intraopera-tive blood salvage). The patient was a 42-year-old man with left occipital meningioma which, clue to mas-sive bleeding, could not be removed even by two-stage operations. In a 3rd stage operation, they could re-move the tumor of 120g totally by the aid of intraoperative replacement using 600ml autologous blood col-lected with a home-made suction apparatus. No adverse side-effect was noted. This procedure was per-formed for 23 cases and it revealed beneficial effects except in one case. In ten of the cases, the procedurewas estimated as a life-saving treatment.

At the present time, the appropriate use of the patients' blood for transfusion therapy is recommendeddue to a shortage of donors. The use of autologous blood could play a key role, not only in saving thehomologous blood supply, but also in avoiding complications encountered in conventional transfusion treat-ments. The methods of 'Autotransfusion' originated from operations in the neurosurgical area. On thataccount, it is desirable that neurosurgeons should be concerned with this subject even now.