་ ඹ ᵝ ᘧ 㸯
Ꮫ ㄳ ồ ㄽ ᩥ ࡢ ෆ ᐜ ࡢ せ ᪨
ㄽ ᩥ ᥦ ฟ ⪅ Ặ ྡ ⥲ ྜ ་ ⒪ ࣭ ᗣ ⛉ Ꮫ 㡿 ᇦ 㞟 ୰ ⒪ ་ Ꮫ ᩍ ⫱ ◊ ✲ ศ 㔝 ᮌ ୗ ⿱ ㈗
㸦 ㄽ ᩥ 㢟 ┠ 㸧
Clotting functional stability of withdrawing blood in storage for acute normovolemic hemodilution: a pilot study
(ᕼ 㔘 ᘧ ⮬ ᕫ ⾑ ㍺ ⾑ ࡢ จ ᅛ ⬟ ࡢ Ᏻ ᐃ ᛶ 㸸 ࣃ ࣟ ࢵ ࢺ ࢫ ࢱ ࢹ )
㸦 ෆ ᐜ ࡢ せ ᪨ 㸧
ᕼ 㔘 ᘧ ⮬ ᕫ ⾑ ㍺ ⾑ (acute normovolemic hemodilution: ANH) ࡣ ㉥ ⾑ ⌫ ࡢ ಖ Ꮡ ࡋ ࡚ 㐠
⏝ ࡉ ࢀ ࠊ⾡ ୰ ࡶ ࡋ ࡃ ࡣ ⾡ ᚋ ࡢ ྠ ✀ ㉥ ⾑ ⌫ ㍺ ⾑ ࡢ ᅇ 㑊 ᭷ ⏝ ࡉ ࢀ ࡚ ࠸ ࡿ ࠋᚰ ⮚ ᡭ ⾡ ࡞ ࡛ ࡣ ࠊ
ྠ ✀ ㉥ ⾑ ⌫ ㍺ ⾑ ࡢ ࣜ ࢫ ࢡ ᅇ 㑊 ຍ ࠼ ࠊจ ᅛ ᅉ Ꮚ ࡸ ⾑ ᑠ ᯈ ࡢ ಖ Ꮡ࣭⿵ ࡋ ࡚ ࡢ ᙺ ࡶ ᮇ ᚅ ࡉ
ࢀ ࡚ ࠸ ࡿ ࠋANH ࡣ ⾑ ᑠ ᯈ ᶵ ⬟ ⥔ ᣢ ࡢ ࡓ ࡵ ᐊ ୗ ࡛ ┞ ಖ Ꮡ ࡋ ࡚ ࠸ ࡿ ࡀ ࠊ จ ᅛ ⬟ 㛵 ࡋ ࡚ ࡣ ⥔ ᣢ ࡉ ࢀ ࡿ 㛫 ࡀ ᫂ ࡞ ࡓ ࡵ ࠊ㛗 㛫 ᡭ ⾡ ࠾ ࠸ ࡚ ㏉ ⾑ ࡢ ࢱ ࣑ ࣥ ࢢ ࡢ Ỵ ᩿ ⱞ ៖ ࡍ ࡿ ࡇ
ࡀ ࠶ ࡿ ࠋᮏ ◊ ✲ ࡛ ࡣ ࠊ᥇ ⾑ ᚋ 24 㛫 ࡲ ࡛ ࡢ ANHࡢ จ ᅛ ⬟ ࢆ ࢺ ࣟ ࣥ ࣎ ࢚ ࣛ ࢫ ࢺ ࣓ ࢺ ࣜ ࣮ (rotational thromboelastometry㸸ROTEM™) ࢆ ⏝ ࠸ ࡚ ᐃ ࡋ ࠊANH ࡢ จ ᅛ ⬟ ࡢ ⤒ ⓗ ኚ
ࡘ ࠸ ࡚ ᳨ ウ ࢆ ⾜ ࡗ ࡓ ࠋ
ᮏ ◊ ✲ ࡣ ๓ ྥ ࡁ ほ ᐹ ◊ ✲ ࡛ ࠶ ࡾ ࠊ ᘯ ๓ Ꮫ Ꮫ 㝔 ་ Ꮫ ◊ ✲ ⛉ ⌮ ጤ ဨ ࡛ ᢎ ㄆ(ᢎ ㄆ ␒ ྕ 2018-1040)ࠊ Ꮫ 㝔 ་ ⒪ ሗ ࢿ ࢵ ࢺ ࣡ ࣮ ࢡ ࢭ ࣥ ࢱ ࣮ ⮫ ᗋ ヨ 㦂 Ⓩ 㘓 ࢩ ࢫ ࢸ ࣒ Ⓩ 㘓 (UMIN000033017)ࡋ ࡓ ᚋ ࠊ ᝈ ⪅ Ⓩ 㘓 ࢆ ⾜ ࡗ ࡓ ࠋANH ⾜ ᇶ ‽ ࡣ ࠊ500 ml ௨ ୖ ࡢ ฟ ⾑ ࡀ ண
ࡉ ࢀ ࡿ ᝈ ⪅ ࠊ⾡ ᚋ ࡢ ࣊ ࣔ ࢢ ࣟ ࣅ ࣥ ್ ࡀ 10 g/dL ௨ ୖ ࡛ ࠶ ࡿ ࡇ ࢆ ⾡ ⪅ ࡽ せ ồ ࡉ ࢀ ࡓ ᝈ ⪅
ࡋ ࡓ ࠋ2018 ᖺ 8᭶ 1᪥ ࡽ 2019 ᖺ 1᭶ 31᪥ ࡲ ࡛ ANH 800 ml ࡀ ⾜ ࡉ ࢀ ࡓ 12ே ࡢ ண ᐃ ᡭ ⾡ ᝈ ⪅ ࡀ Ⓩ 㘓 ࡉ ࢀ ࡓ ࠋ ㌟ 㯞 㓉 ᑟ ධ ᚋ ࠊ ୰ ᚰ 㟼 ⬦ ㊰ ࢆ ☜ ಖ ࡋ ࠊ ᖹ ᆒ ⾑ ᅽ 60 mmHg ௨ ୖ ⥔ ᣢ ࡉ ࢀ ࡿ ࡼ ࠺ 500 ml ࡽ 1000 ml ࡢ 6 % ࣄ ࢻ ࣟ ࢟ ࢩ ࢚ ࢳ ࣝ ࢹ ࣥ ࣉ ࣥ 〇 ࢆ ᢞ ࡋ ࡞ ࡀ ࡽ 800 mlࡢ ⾑ ᾮ ࢆ ᥇ ⾑ ࡋ ࡓ ࠋ ᥇ ⾑ ᚋ ࡢ ⾑ ᾮ ࣂ ࢵ ࢢ ࡢ ࢩ ࣮ ࣜ ࣥ ࢢ 㒊 ࡼ ࡾ ⣙ 10 mL ࡢ
⾑ ᾮ ࢆ CPD ⁐ ᾮ 1.5 mL ࡢ ධ ࡗ ࡓ ヨ 㦂 ⟶ ᥇ ྲྀ ࡋ ࠊ ᐊ ୗ 60-80 ᅇ/ศ ࡛ ┞ ಖ Ꮡ ࡋ ࡓ ࠋ จ ᅛ ⬟ ࡣ ROTEMτ ࢆ ⏝ ࠸ ࡚ ᥇ ⾑ ┤ ᚋ 㸦1 㛫 ௨ ෆ 㸧ࠊ4ࠊ8ࠊ12ࠊ24 㛫 ᚋ ᐃ ࡋ ࠊ ṇ ☜ ᛶ ࢆ ಖ ド ࡍ ࡿ ࡓ ࡵ ࠊ ᐃ ࡣ 2 ே ࡢ ་ ᖌ ࡼ ࡗ ࡚ ⾜ ࢃ ࢀ ࡓ ࠋ ྛ Ⅼ ࠾ ࡅ ࡿ extrinsically-activated test with tissue factor (EXTEM)ࠊintrinsically-activated test using ellagic acid (INTEM)ࠊfibrin-based extrinsically activated test with tissue factor (FIBTEM)ࡢ จ ᅛ 㛫 (clotting time: CT)ࠊ ⾑ 㣰 ᙧ ᡂ 㛫 (clot formation time: CFT)ࠊ ᭱
⾑ 㣰 ◳ ᗘ (maximum clot firmness: MCF)ࢆ ᐃ ࡋ ࡓ ࠋ ྛ Ⅼ ࡢ EXTEMࠊINTEMࠊ FIBTEM ࡢ MCF ࡽ ᭱ ⾑ 㣰 ᙎ ᛶ 㸦maximum clot elasticity: MCE㸧 ࢆ ⟬ ฟ ࡋ ࠊEXTEM
FIBTEM ࡢ MCE ࡢ ᕪ ࡼ ࡾ ⾑ ᑠ ᯈ ࡢ ⾑ 㣰 ᙧ ᡂ ࡢ ᐤ ࡘ ࠸ ࡚ ᳨ ウ ࡋ ࡓ ࠋ ⤫ ィ Ꮫ ⓗ ᳨ ウ ࡣ repeated measures one-way ANOVA ࢆ ⏝ ࠸ ࠊBonferroni̓s test ࡼ ࡾ ᥇ ⾑ ┤ ᚋ ྛ
Ⅼ ࡢ ᐃ ್ ࢆ ẚ ㍑ ᳨ ウ ࡋ ࠊp 㸺 0.05 ࢆ ⤫ ィ Ꮫ ⓗ ᭷ ព ᕪ ࠶ ࡾ ࡋ ࡓ ࠋ
᥇ ⾑ ┤ ᚋ ࡢ ROTEMτ ࡢ ྛ ್ ࡣ ᇶ ‽ ⠊ ᅖ ෆ ࡛ ࠶ ࡗ ࡓ ࠋEXTEMࠊINTEMࠊFIBTEM ࡢ CT ࡣ ⤒ ⓗ ࡞ ኚ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ ࠋEXTEM INTEM ࡢ CFTࡣ ⤒ ⓗ ᘏ 㛗 ࡋ ࠊ᥇ ⾑ ᚋ 24 㛫 ࡢ EXTEM ᥇ ⾑ ᚋ 12 㛫 ࡢ INTEM ࡢ CFT ࡣ ᭷ ព ᘏ 㛗 ࡋ ࡓ ࠋ FIBTEM ࡢ MCF ࡣ
⤒ ⓗ ኚ ࢆ ㄆ ࡵ ࡞ ࡗ ࡓ ࡀ ࠊEXTEM INTEM ࡢ MCF ࡣ ⤒ ⓗ ῶ ᑡ ࡋ ࡓ ࠋ EXTEM ࡢ MCF ࡣ ᥇ ⾑ ᚋ 8 㛫 ࡽ ᭷ ព ῶ ᑡ ࡋ ࡓ ࡀ ࠊ8 㛫 ࡢ ್ ࢆ ྵ ࡵ ࡚ ࡢ ್ ࡀ ṇ ᖖ ⠊ ᅖ ෆ ࡛
࠶ ࡗ ࡓ ࠋEXTEM࠾ ࡼ ࡧ INTEMࡢ MCF ࡢ ᭱ ኚ ⋡ ࡣ ࠊ ࡑ ࢀ ࡒ ࢀ 12.4㸣 㸦95㸣 ಙ 㢗 ༊ 㛫㸸9.0̽ 15.8㸧࠾ ࡼ ࡧ 11.6㸣㸦95㸣 ಙ 㢗 ༊ 㛫㸸6.8̽ 16.4㸣 㸧࡛ ࠶ ࡗ ࡓ ࠋEXTEM INTEM
ࡢ MCE ࡣ ⤒ ⓗ ᖜ ῶ ᑡ ࡋ ࡓ ࡀ ࠊFIBTEM ࡢ MCE ࡣ ኚ ࡋ ࡞ ࡗ ࡓ ࠋ MCEEXTEM-MCEFIBTEM ࡣ ࠊ ᥇ ⾑ ᚋ 8 㛫 ࡽ ᭷ ព ῶ ᑡ ࡋ ࠊ MCEEXTEM-MCEFIBTEM ࡢ ᭱ ኚ ⋡ ࡣ ࠊ᥇ ⾑ ᚋ 24 㛫 ࡛ 30.2㸣㸦95㸣 ಙ 㢗 ༊ 㛫㸸17.6
̽ 42.9㸣 㸧 ࡛ ࠶ ࡗ ࡓ ࠋ
FIBTEM ࡢ ್ ⾑ ₢ ࣇ ࣈ ࣜ ࣀ ࣮ ࢤ ࣥ ್ ࡣ 㠀 ᖖ ᙉ ࡃ ┦ 㛵 ࡋ ࡚ ࠸ ࡿ ࡉ ࢀ ࠊFIBTEM ࡢ MCF ࡀ ⥔ ᣢ ࡉ ࢀ ࡿ ࡇ ࡣ ࠊ᥇ ⾑ ᚋ 24 㛫 ࣇ ࣈ ࣜ ࣀ ࣮ ࢤ ࣥ ⃰ ᗘ ࡀ ኚ ࡋ ࡞ ࠸ ࠸ ࠺ ඛ ⾜ ◊
✲ ࡢ ⤖ ᯝ ࡶ ྜ ⮴ ࡋ ࡚ ࠸ ࡿ ࠋ ⾑ ᑠ ᯈ ࡢ ⾑ 㣰 ᙧ ᡂ ࡢ ᐤ ᗘ ࢆ ♧ ࡍ MCEEXTEM-MCEFIBTEM ࡣ ࠊ ᥇ ⾑ ᚋ 8 㛫 ࡽ ⤒ ⓗ ᭷ ព ῶ ᑡ ࡋ ࠊ MCEEXTEM-MCEFIBTEM ࡢ ᭱ ኚ ⋡ ࡣ ࠊ᥇ ⾑ ᚋ 24 㛫 ࡛ ⣙ 30㸣 ࡛ ࠶ ࡗ ࡓ ࠋ ⾑ ࡀ ᐊ ࡛ ಖ Ꮡ ࡉ ࢀ ࠊヨ 㦂 ⟶ ෆ ᫂ ࡽ ࡞ ⾑ 㣰 ᙧ ᡂ ࡀ ࡞ ࡗ ࡓ ࡋ ࡚ ࡶ ࠊ⾑ ᑠ ᯈ ᶵ ⬟ ࡲ ࡓ ࡣ ⾑ ᑠ ᯈ ᩘ ࡣ ⤒ ⓗ ప ୗ࣭ῶ ᑡ ࡍ ࡿ ྍ ⬟ ᛶ ࡀ ࠶ ࡿ ࠋ
⾑ ᑠ ᯈ ᶵ ⬟ ࡲ ࡓ ࡣ ⾑ ᑠ ᯈ ᩘ ࢆ ⥔ ᣢ ࡍ ࡿ ほ Ⅼ ࡽ ࠊ࡛ ࡁ ࡿ ࡔ ࡅ ᪩ ࡃ ᝈ ⪅ ANH ࢆ ㍺ ⾑ ࡍ ࡿ ࡇ
ࡀ 㐺 ษ ࡛ ࠶ ࡿ ྍ ⬟ ᛶ ࡀ ࠶ ࡿ ࠋ
⤖ ㄽ ࡋ ࡚ ࠊ⾑ ᑠ ᯈ ᡂ ศ ࣃ ࣛ ࣓ ࣮ ࢱ ࣮ ࡛ ࠶ ࡿ MCEEXTEM-MCEFIBTEMࡣ ࠊ᥇ ⾑ ᚋ 8 㛫 ࡽ ⤒ ⓗ ᭷ ព ῶ ᑡ ࡋ ࡓ ࡀ ࠊFIBTEM ࡢ MCF ࡣ ኚ ࡏ ࡎ ࠊEXTEM ࠾ ࡼ ࡧ INTEM ࡢMCF 㛵 ࡋ ࡚ ࡶ ᥇ ⾑ ᚋ 24 㛫 ᚋ ᇶ ‽ ⠊ ᅖ ෆ ࡛ ࠶ ࡗ ࡓ ࠋᐊ ࡛ ┞ ಖ Ꮡ ࡉ ࢀ ࡓ ANHࡀ ࠊ ᥇ ⾑ ᚋ ᑡ ࡞ ࡃ ࡶ 8 㛫 ࡲ ࡛ ࡣ Ṇ ⾑ ࡢ ┠ ⓗ ࡛ ⏝ ࡛ ࡁ ࡿ ࡇ ࢆ ♧ ၀ ࡋ ࡓ ࠋᝈ ⪅ ࡢ Ṇ ⾑ 㛵 ࡋ
࡚ ANH ࡢ ㍺ ⾑ ࢆ 㐜 ࡽ ࡏ ࡓ ᝈ ⪅ ࡢ ⮫ ᗋ ⓗ ᙳ 㡪 ࢆ ゎ ᫂ ࡍ ࡿ ࡣ ࠊ ᭦ ࡞ ࡿ ◊ ✲ ࡀ ᚲ せ ࡛ ࠶ ࡿ ࠋ
