不可視出血を含めた出血量からみた人工股関節全置換術に対する回収式自己血の適応

抄録

Objective: We performed total hip arthroplasty (THA), combined with preoperative autologous blood transfusion and perioperative cell salvage. Phlebotomy for the preoperative autologous blood transfusion was undertaken one month before surgery and the cell salvage device, OrthoPAT^®, was used intraoperatively and postoperatively. We examined the effect and utility of cell salvage during the perioperative period.

Methods: 140 patients were included in the study, and they received both perioperative cell salvage and 400 mL of preoperative autologous blood transfusion for primary THA in the period from May 2013 to June 2014, inclusive. Hematometry was performed before collection for the preoperative autologous phlebotomy, immediately in the postoperative period and at one and seven days postoperatively. From results of the hematometry, we estimated perioperative blood loss including the calculated blood loss.

Results: In the group where the OrthoPAT^® did not indicate the need for erythrocyte salvage, there was significantly less operative hemorrhaging, or bleeding in the postoperative drain compared to the control group. Moreover, the autologous hematocrit was low. There was a tendency that when there was a large amount of erythrocyte salvage there was also a greater amount of multiple haemorrhaging in addition to bleeding in the postoperative drain.

Conclusions: In view that perioperative blood loss cannot be estimated prior to surgery, and the average volume of blood loss including the calculated blood loss can exceed more than 600 mL, it is recommended to prepare for perioperative cell salvage. We consider that perioperative cell salvage is one effective choice as a measure against bleeding during THA.