腰椎変性疾患手術例における自己血輸血の検討

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  • Autotransfusion in Lumbar Spine Surgery
  • ヨウツイ ヘンセイ シッカン シュジュツレイ ニ オケル ジコ ケツ ユケツ ノ ケントウ

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Objective: We studied the effectiveness of autotransfusion by preoperative blood donation on lumbar spine surgery carried out at our hospital.<br>Methods: The study was based on 311 cases of surgery performed for lumbar spine injury during the period 2005-2007 for which the avoidance of allogeneic transfusion by means of autotransfusion was carried out. There were 113 male and 298 female subjects with an average age of 60.8 years at the time of surgery. The study looked at (1) the avoidance of autotransfusion; (2) the type of surgery and amount of bleeding, classifying surgery according to vertebra number and the use or nonuse of instruments; (3) the change in hemoglobin level before and after surgery; and (4) the discarding of (surplus) donated autologous blood in the above cases.<br>Results: Allogeneic blood transfusion was judged necessary in one case, giving a total avoidance rate of 99.7%. No complications with the patient were identified at the time of blood donation. In cases where instruments were used, bleeding was between 50 and 3600 g, averaging 944 g; in cases where instruments were not used, bleeding ranged from small amounts to 1400 g, averaging 286 g. Preoperative blood donation ranged from 400 to 1200 g, averaging 664 g. The hemoglobin concentration in the donated blood averaged 13.8 g/ml; following donation, the level was 12.7 g/ml just prior to surgery, 11.4 g/ml on the day after surgery, and 12.6 g/ml 2 weeks following surgery.<br>Conclusion: Bleeding and surgical time increase with vertebra number; both were significantly higher in cases with instrument use than in cases without instrument use. With an avoidance of allogeneic blood transfusion of 99.7%, autotransfusion by preoperative blood donation was found to be effective.

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