Moskowitz David M, Perelman Seth I, Cousineau Katherine M, Klein James J, Shander Aryeh, Margolis Eric J, Katz Steven A, Bennett Henry L, Lebowitz Nate E, Ergin M Arisan
Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey 07631, USA.
Can J Anaesth. 2002 Apr;49(4):402-8. doi: 10.1007/BF03017330.
To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest.
A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one week after the operation with a hemoglobin of 10.2 g x dL(-1) and a hematocrit of 31.2%.
Multiple blood conservation techniques were employed to manage this Jehovah's Witness patient through complex cardiac surgery, which was previously denied to him at other institutions. The successful outcome of this patient, while respecting the right to refuse allogeneic blood products, is a result of a multidisciplinary collaboration as well as the application of established blood conservation techniques.
强调对一名接受体外循环（CPB）和深低温循环停搏的耶和华见证会手术患者的管理。
一名47岁男性耶和华见证会信徒，患有肾细胞癌，因左肾根治性切除术及切除延伸至下腔静脉（IVC）与右心房（RA）交界处的肿瘤血栓入院。术前目标是使红细胞量最大化，明确肿瘤延伸范围，并制定包含血液保护策略以尽量减少失血的手术计划。做了腹部正中切口，以优化从腹腔区域切除肿瘤的非腔静脉部分。采用CPB和深低温循环停搏来协助从IVC和RA切除肿瘤。术中血液保护策略包括使用急性等容血液稀释、抗纤溶药物、细胞回收、肝素和鱼精蛋白血药浓度的床旁监测、白细胞滤器以及精细的手术技术。患者成功脱离CPB，被转运至心胸重症监护病房，无并发症。患者术后一周出院，血红蛋白为10.2 g×dL⁻¹，血细胞比容为31.2%。
采用了多种血液保护技术来管理这名耶和华见证会患者接受复杂心脏手术，而此前其他机构拒绝为其进行此类手术。该患者的成功结局，在尊重其拒绝异体血制品权利的同时，是多学科协作以及应用既定血液保护技术的结果。
