초록
개심술시 출혈에 따른 동종수혈은 응혈이상증, 간염, 후천성면역결핍증, 과민반응 등의 부작용을 초래할 수 있다. 동종수혈을 줄이는 한 방법으로 자가수혈기의 사용이 보편화 되어있다. 계명대학교 흉부외과학 교실에서는 1993년 7월부터 1996년 7월까지 개심술을 받은 40명의 환자를 대상으로 cell saver를 이용하여 자가수혈을 받은 실험군 20명과 대조군 20명으로 나누어 수혈량, 흉관을 통한 출혈량, 혈액학적 소견, 혈액응고상태 등을 비교하였다. 술후 출혈량은 양군 간의 유의한 차이가 없었고, 수혈량은 실험군에서 2.91$\pm$1.72 units로 대조군의 4.82$\pm$1.72 units에 비해 의미있게 감소하였다. cell saver를 이용하여 얻어진 처리혈의 구성성분은 hemoglobin 17.4gm%, hematocrit 56.4%, RBC 5,780,000/ul, WBC 9,900/ul, platelet 33,000/ul, sodium 147.4mEq/L, potassium 2.9mEq/L로 나타났다. 처리혈을 세균배양한 결과 20례중 1 례에서 staphylococcus epidermidis가 배양되었으나 감염에 따른 합병증은 없었다. 그리고 자가수혈기 사용에 따른 합병증예도 없었다.
Homologous blood transfusion entails substantial risks, including allergic reactions, transmission diseases such as hepatitis, acquired immunodeficiency syndrome. Autotransfusion system is a common method of reducing the need for homologous blood transfusion during cardiac operation. Between July 1993 and July 1995, a series of 40 patients undergoing open heart surgery was selected to an autotransfusion group(n=20) or a control group(n=20). The cell saver system(AT1000, Electromedics, Englewood, CO, USA) was employed for autotransfusion. With this system, shed blood in operative field during cardiopulmonary bypass(CPB) and remained blood in cardiotomy reservior after CPB was aspirated by means of a locally heparinized collecting system. After centrifuge salvaged blood, the resulting red cell concentrate reinfused subsequently. The amounts of blood loss were 766.5$\pm$121.3 ml in cell saver group, 770.1$\pm$113.6 ml in control group, and there were no significant differences between two groups(P=NS). The amounts of blood transfused were 2.91$\pm$1.72 units in cell saver group, 4.82$\pm$1.72 units in control group. Composition of processed blood by cell saver was hemoglobin 17.4 gm%, hematocrit 56.4%, RBC 5,780,000/ul, WBC 9,900/ul, and platelet 33,000/ul. There was no complication related to cell saver. Conclusively, cell saver autotransfusion system is safe, effective method for reducing the homologous blood trasfusion in cardiac surgery.
