• Journal of Chest Surgery
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• 제46권3호
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• pp.185-191
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• 2013

Background: Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. Materials and Methods: Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. Results: There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. Conclusion: Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.

• Journal of Medicine and Life Science
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• 제18권1호
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• pp.11-15
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• 2021

In elderly patients, the vital parameters tend to fluctuate based on the blood volume status, which may cause sudden hypovolemic shock if the postoperative bleeding continues. Particularly, those who undergo surgery for arthritis needs to pay extra attention because the bleeding may persist over the joints after the surgery. Therefore, appropriate pain control is required to reduce the postoperative blood loss. This retrospective chart review study was conducted to assess the postoperative pain control and reduction of blood loss with a single injection of saphenous nerve block (SNB) in elderly patients with osteoarthritis. We reviewed the electronic medical records of patients who underwent knee total arthroplasty with spinal anesthesia between January and May 2016. A total of 51 patients participated in this study. All patients were treated with intravenous patient-controlled analgesia for the postoperative pain control, and additional analgesic agents were administered at a visual analogue scale above a score of 6. In 25 patients, SNB was performed using ultrasound with the administration of 0.75% ropivacaine (15 mL) after the surgery. Patients who received additional analgesics were significantly low in the nerve block group (P=0.009). Additionally, the volume of blood loss from catheter drainage was significantly low at 2 and 3 days postoperatively (P=0.013 and P=0.041, respectively) in the nerve block group. In patients who underwent total knee arthroplasty with osteoarthritis, only a single injection of saphenous nerve block was sufficient for the postoperative pain control and reduced bleeding.

• Journal of Chest Surgery
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• 제31권10호
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• pp.952-963
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• 1998

연구배경 : 체외 순환으로 인한 지혈 기전의 심각한 손상은 술후 과다 출혈을 일으켜 환자의 생명을 위협하고, 대량 수혈에 따른 부작용과 재수술의 우려마저 증가시킬 수 있다. 특히, 심장 수술동안 섬유소 용해계의 활성화와 혈소판의 숫적, 기능적 변화가 술후 상당 시간동안 출혈의 원인이 된다고 보고하고 있다 대상 및 방법 : 본 연구는 체외 순환 동안 및 그 후에 있어, 체외 순환에 의한 섬유소 용해계의 활성화를 포함한 다양한 혈액학적 변화를 조사하고, 이러한 변화들이 술후 비외과적 출혈의 정도와 어떤 상관성이 있는가를 규명하기위해 체외 순환을 실시할 성인 환자 20명을 대상으로 전향적으로 계획되었다. 혈소판 수, 섬유소원 및 plasminogen 농도, FDP, D-dimer, BT, aPTT, PT와 같은 혈액학적 변수의 측정을 위해 수술동안 또는 술후 시기에 혈액을 연속적으로 채취하였다. 출혈량은 흉부 삽관을 통한 배출량을 술후 3, 6, 12, 24, 48시간의 양과 총혈액량을 각각 측정하였다. 결과 : 연구 결과를 요약하면 다음과 같다:혈소판 수는 체외 순환으로 인해 급격히 감소되었다 (p<0.01). 총 체외 순환 시간이 길수록 혈소판 수의 감소률은 더 높았으며 (r=0.55, p=0.01) 술후 7일이 되어서야 비로소 술전치에 근접하였다. 체외 순환동안 FDP와 D-dimer의 농도가 의미있게 증가하였고 (p<0.0001), 섬유소원 및 plasminogen 농도 둘 다 서로간에 상관성을 보이면서 감소하였다 (r=0.57, p<0.01). 술후 2hr-BT, 2hr-PT, 2hr-aPTT 모두 술전치에 비해 유의하게 연장되었다(각각 p<0.05, p<0.0001, p<0.0001). 술후 총 출혈량과 환자의 연령, 대동맥 차단 시간, 체외 순환 시간은 각각 양의 상관관계 (positive correlation)가 있었다. 술전 기준치 혈소판 수와 술후 3시간 출혈량, 체외 순환 종료시의 혈소판 수와 술후 3시간, 6시간 및 총 출혈량 그리고 술후 1일의 혈소판 수와 48시간 출혈량 사이에는 각각 음의 상관관계 (negative correlation)가 있었다. 술후 2hr-aPTT는 술후 6시간 및 48시간대의 출혈량에 상관성이 있었고 (r=0.53, p=0.02) 술후 2hr-PT는 48시간 출혈량과 각각 양의 상관성이 있었으나 (r=0.43, p=0.05). 이 두가지 변수와 총 출혈량 간에는 상관성이 없었고, 술후 2hr-BT와 술후 출혈량 사이에도 유의한 상관성을 발견하지 못하였다. 결론 : 이상의 관찰 결과들은 체외 순환이 섬유소 용해계의 활성화와 혈소판 수의 심한 감소를 포함한 다양한 혈액학적 변화를 유도하고 환자의 연령, 혈소판 수, 대동맥 차단 시간, 체외 순환 시간, 술후 PT 및 aPTT와 같은 다인적 상황들이 술후 출혈에 영향을 미친다는 점들을 시사하고 있다. 본 연구 결과들은 체외 순환에 따른 지혈적 손상에 관한 이해와 술후 출혈을 감소시키기 위한 기초 자료로 활용 가능하리라 사료된다.

• 대한의생명과학회지
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• 제7권1호
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• pp.7-15
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• 2001

Although extracorporeal circulation (ECC) has been routinely used for cardiovascular surgery, hyperoxemia during ECC may produce oxygen toxicity and cellular injury. This study was performed to investigate the clinical influences of hyperoxemic ECC during cardiovascular operation. 40 adult patients scheduled for elective cardiovascular surgery were classified into normoxemic (arterial oxygen tension: 115 mmHg, n＝20) and hyperoxemic (arterial oxygen tension: 380 mmHg, n＝20) ECC. At preoperative and postoperative period, total leukocyte and neutrophil counts, platelet counts, iron, glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine in peripheral arterial blood, malondialdehyde (MDA) and troponin-T concentration (TnT) in coronary sinus blood, pulmonary vascular resistance (PVR), and postoperative blood loss volume (BLS) were measured and compared between groups. Hyperoxemic group had postoperatively higher total leukocyte and neutrophil counts, MDA, TnT, PVR total BLS, iron, glucose, AST, ALT, BUN, and creatinine than normoxemic group (p<0.05).0 conclusion, hyperoxemic ECC results in greater inflammatory response and oxidative damaging effects on the heart lung, liver and kidney, probably being adverse to postoperative patient recovery. For reducing these deleterious effects and improving postoperative outcomes, management lowering oxygen tension during ECC is recommended.

• Journal of Chest Surgery
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• 제23권2호
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• pp.268-274
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• 1990

Bleeding after cardiopulmonary bypass remains a cause for concern, requiring reexploration of the chest in approximately 3 percent of patients who have had operations on the heart. We examined the possibility that this problem might be alleviated by desmopressin acetate [DDAVP], synthetic vasopressin analogue that lacks vasoconstrictor activity. In a prospective, randomized trial, we studied the effect of intraoperative desmopressin acetate in 20 patients [the treated group 10 patients and the control group 10 patients] undergoing various cardiac operations requiring cardiopulmonary bypass. The result showed that the early postoperative [during first 24hrs] and mean postoperative blood loss [first 3 days] of the treated group were significantly reduced than the control group[447\ulcorner199ml in the treated group versus 746\ulcorner199ml in the treated group versus 746\ulcorner295 ml in the control group, p=0.014; mean\ulcornerstandard deviation and 675\ulcorner276 ml in the treated group versus 1006\ulcorner303 ml in control group, p=0.019]. The mean red-cell transfusion in first 3days were reduced in the treated group than the control group [3.3\ulcorner1.7 units vs 4.9\ulcorner1.7units, P=0.051]. There were no untoward side effects of desmopressin acetate. We conclude that the administration of desmopressin acetate can be recommended to reduce blood loss and blood conservation in patients undergoing cardiac operations.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1048-1054
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• 1992

With use of a simple, inexpensive and nonpharmacological program for blood conservation, 24 consecutive patients underwent elective or urgent coronary artery bypass grafting without need of homologous red cell transfusions and /or fresh frozen plasma transfusions in 16 patients[66.7%]. Left internal mammary artery graftings were done in 18 patients[75%], with supplemental saphenous vein grafts in all. Intraoperatively, autologous heparinized blood was removed before bypass and retransfused at the conclusion of ext-racorporeal circulation. The volume remaining in the oxygenator and tubing set was returned without cell processing or hemofiltration. Using the hard-shell cardiotomy reservoir from the oxygenator, autotransfusion of the shed mediastinal blood was continued hourly by the next early;norning. The mean postoperative mediastinal blood loss was 364$\pm$234ml, whereas 553$\pm$383ml was autotransfused. 4 patients [16.7%] received homologous blood and an additional 4 patients[16.7%] fresh frozen plasma. Thus, in total, 16 patients[66.7%] were not exposed to any homologous blood products during the hospital stay. At discharge, the mean hemoglobin concentration was 10.3$\pm$1.6g /dl. Postoperative complications were few and there was no hospital death.

• 대한정형외과학회지
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• 제56권2호
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• pp.142-149
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• 2021

목적: 일차 슬관절 전치환술을 받은 환자들에게서 트라넥삼산의 효능을 확인하고, 트라넥삼산의 정맥 내 사용 방법과 관절 내 투여 군을 비교하여 어떤 방법이 혈액 손실 감소 효과가 더 있는지 알아보고자 하였다. 대상 및 방법: 이 연구는 광주보훈병원에서 2017년 3월부터 2019년 2월까지 일차 슬관절 전치환술을 받은 환자들에 대한 후향적 연구이다. 단측 일차 슬관절 전치환술을 시행 받은 총 210명의 환자가 연구에 포함되었다. 트라넥삼산 사용 방법에 따라 각각 70명의 환자들에 대해 3개의 그룹으로 나누었다(Group I: 정맥 내 투여 군, Group II: 관절 내 투여 군, Group III: 트라넥삼산을 사용하지 않은 군). 그룹 간 수술 후 총 실혈량, 헤모글로빈 감소치, 수혈 단위를 비교하였다. 결과: 총 실혈량은 관절 내 투여 군(1,136±339 ml) 및 트라넥삼산을 사용하지 않은 군(1,366±866 ml)보다 정맥 내 사용 군(987±449 ml)에서 더 낮았다(p=0.004). 수술 후 헤모글로빈의 손실 또한 정맥 내 사용 군(1.8 g/dl)에서 관절 내 투여 군(2.9 g/dl)이나 투여하지 않은 군(3.5 g/dl)보다 현저히 낮았다(p<0.01). 수혈 빈도는 트라넥삼산을 사용하지 않은 그룹(5.7%)에서 더 높았으며 정맥 내 사용 시 1.4%를 보이고, 관절 내 투여한 군에서 수혈을 받은 환자는 없었다. 혈전색전증의 발생 빈도는 그룹 간 통계적으로 유의하지 않았다. 결론: 일차 슬관절 전치환술 시행 시 트라넥삼산을 사용한 환자 군에서 사용한지 않은 군에 비해 총 실혈량을 유의하게 감소시켰고, 관절 내 투여보다는 정맥 내로 투여하는 것이 더 효과적이었다. 정맥 내 투여로 인한 합병증은 관절 내 투여 및 트라넥삼산을 사용하지 않은 군과 비교해 유의한 차이는 없었다.

• Journal of Chest Surgery
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• 제25권5호
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• pp.526-532
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• 1992

The effect of cardiopulmonary bypass on platelet count and function was studied in 20 patients who underwent cardiac operation from April 1991 to August 1991 at the Department of thoracic and Cardiovascular Surgery, School of Medicine, Keimyung University. Ten patients were perfused with a bubble oxygenator, 10 with a membrane oxygenator. During and after bypass, platelet counts decreased in both groups and significantly reduced in those perfused with a bubble oxygenator. All 20 patients studied for platelet functions had an abnormal postoperative aggregation response to collagen and epinephrine, but no significant difference in both groups. One hour after bypass, bleeding times increased in both groups but did not differ significantly between groups. Postoperative 24 hour blood losses were significantly higher in patients perfused with a membrane oxygenator. Platelet damage and postoperative blood loss are less severe after cardiopulmonary bypass performed with a membrane oxygenator than with a bubble oxygenator.

• Journal of Chest Surgery
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• 제32권4호
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• pp.364-367
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• 1999

배경: 1994년 1월부터 1996년 12월까지 부산대학교병원 흉부외과에서 인공판막 치환술을 받은 40명의 환자를 대상으로 aprotinin 투여군 20명과 투여하지않은 대조군 20명으로 나누어 비교 분석하였다. 대상 및 방법: Aprotinin 투여군은 수술시작 30분이내에 200만 KIU를 정주하고 충전액에 100만 KIU를 첨가하였고 유지용량으로 수술하는 동안 시간당 50만 KIU를 투여하였다. 술전과 술후 혈색소치, 혈소판치, prothrombin time을 측정하였고 출혈량은 술후 6시간, 24시간 술후 총량을 측정하였다. 결과: 출혈량은 Aprotinin 투여군에서 대조군보다 통계학적으로 유의하게 적었고 수혈량도 Aprotinin 투여군에서 대조군보다 적었다. 결론: 저자는 aprotinin의 사용이 개심술시 출혈량과 수혈요구량을 현저히 줄이고 술후 지혈에도 도움을 준다고 생각된다.

• Journal of Gastric Cancer
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• 제22권1호
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• pp.56-66
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• 2022

Purpose: Nutritional problems after gastrectomy affect continuation of postoperative chemotherapy. There have been no studies limited to total gastrectomy, which is particularly prone to nutritional problems. In this study, we aimed to investigate the factors that predict the continuation of postoperative chemotherapy. Materials and Methods: We included 101 patients who underwent curative total gastrectomy and postoperative chemotherapy at Hiroshima Memorial Hospital. The effects of 37 factors, including perioperative inflammatory, nutritional, and tumor status, on the persistence of postoperative chemotherapy were analyzed. Results: In univariate analysis of preoperative factors, age, carbohydrate antigen 19-9, platelet-to-neutrophil ratio, Onodera's prognostic nutritional index (PNI), controlling nutritional status score, and nutritional risk screening (NRS-2002) score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of preoperative factors, age (≥74 years) was an independent factor for a shorter duration of postoperative chemotherapy (hazard ratio [HR], 5.24; 95% confidence interval [CI], 2.19-12.96; P<0.01). In univariate analysis of factors before postoperative chemotherapy, intraoperative blood loss, perioperative weight loss rate, postoperative performance status, PNI, albumin-to-bilirubin index, and NRS-2002 score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of factors before postoperative therapy, age (≥74 years) (HR, 5.75; 95% CI, 1.90-19.49; P<0.01) and PNI (<39) (HR, 3.29; 95% CI, 1.26-8.56; P=0.02) were independent factors for a shorter duration of postoperative chemotherapy. Conclusions: Age and PNI are useful predictors of postoperative chemotherapy intolerance after total gastrectomy and may determine the treatment strategy and timing of chemotherapy initiation.