유도 저혈압하 양악 교정수술시 급성 동량성 혈액희석이 출혈량과 수혈량에 미치는 영향

Abstract

Backgroungd: To avoid complications of homologous transfusion, many methods are being used in patients who undergo an operation, and autologous transfusion is the most popular modality. Acute normovolimic hemodilution (ANH) is recognized as the easiest, the most economical and valuable autologous blood saving method among the types of autotransfusion. This study was performed to investigate the clinical usefulness of ANH under inducd hypotensive anesthesia to reduce blood loss and homologous transfusion in orthognathic two jaw operation. Methods: Thirty patients were randomized divided into two groups; with ANH (n = 15) and without ANH (n = 15). The surgery was limited to one surgeon, with genioplasty, and no bone graft. All patients were pre-donated 2 units of autologous blood before operation. All the surgery was done under induced hypotension by nitroglycerine and esmolol, target mean arterial pressure was aimed at 70% of preoperative blood pressure. In with ANH group, autologous blood were procured immediately after anesthetic induction while 6% hydroxyethyl starch solution were infused to maintain normovolemia until lowering hematocrit to 28%. Results: The two groups did neither differ significantly with demographic data and preoperative evaluation finding. Nor in operation time, surgeon´s satisfiaction to surgical field, serial central venous pressure, hematocrit´s value, prothrombin time, activated partial thromboplastin time. All patients needed transfusion of pre-dunated 2 units of autologous blood during operation, but there was significantly reduced demand for homologous packed RBC transfusion in the with ANH group compared with the control group (0.0 ± 0.0 unit vs. 1.7 ± 1.2 unit, P = 0). Blood saving effects was so greater in with ANH group (total blood loss; 1110.0 ± 154.9 ㏄ vs. 833.3 ± 156.6 ㏄, P = 0). In addition, the amount of agents for induced hypotension was smaller in with ANH group (nitroglycerine: 11.3 ± 2.4 ㎎ vs. 9.9 ± 2.4 ㎎, P = 0.012, esmolol: 52.0 ± 28.2 ㎎ vs. 14.6 ± 8.3 ㎜, P = 0). Conclusions: ANH with pre-donated antologous blood under induced hypotension can reduce intraoperative blood loss and homologous transfusion requirements in othhognathic two jaw operation.