J.Jpn. Surg. Soc.. 60(6): 944-961, 1959
STUDIES ON THE MECHANICAL HEART AND LUNG ESPECIALLY ON THE CAUSE AND THE COUNTERMEASURE OF POST-OPERATIVE HEMORRHAGE
|
1st Surgical Department, Nagoya University School Medicine (Director: Prof. Yoshio HASHIMOTO) Shinji TAKEUCHI |
In above mentioned experiments, I have investigated the following changes through the extracorporeal circulation-plasma fibrinogen, blood platelet count, prothrombin time, plasma calcium, coagulation time, bleeding time, thrombelastogram, blood retraction, fibrinolytic activity, hemolysis and some aspects of coronary vein blood. According to the results of these investigations, it was pointed out that the most serious change after the extracorporeal circulation was the decrease in platelet count, and the reduction of "ma" value in thrombelastogram and that of blood retraction were also indicated. Considerable improvement on these changes was, however, shown when I used a Sigma pump instead of a Vanton pump.
As for the neutralization of heparin, by administration of protamine 1.5-2.0 times of the amount of the previously administrated heparin, the action of heparin was, completely and safely neutralized, but the caution againist the heparin rebound phenomenon should always be taken.
With the object of pursuing the influence of blood dilution, to come up blood, coagulation, I have performed experiments in which blood dilution in various degrees was made with dogs by administrating physiological saline solution intravenously the same amount with blood-letting volume, and the examinations concerning to the blood coagulation were performed.
As results, even if when the dilution of blood reached to about 50%, the hemorrgagic tendency was never seen in thrombelastogram and blood retraction test it was rather observed that the shortening of the bleeding time and the coagulation time, notwithstanding the fact that hematocrit, red cell count, platelet count, plasma fibrinogen and plasma protein were also decreased as much as the degree of blood dilution.
By these studies, having got a conclusion that the main cause of hemrrrhagic tendency after the extracorporeal circulation is due to the impair ment of blood platelets, the author performed fresh platelet infusion to dogs after the extracorporeal ciaculation. As results, the blood coagulation turned to normal immediately after the infusion, and bleeding could be decreased.
Further, the extracorporeal circulation similar to the physiological one by using the heart and lung machine non-destractiv to blood, is essentially desired not only for the benefit of minimizing the post-hemorrhage, but also for the improvement of th safety and the utility of the artificial heart and lung.
To read the PDF file you will need Adobe Reader installed on your computer.