Joseph Samuel Abraham, Berekashvili Ketevan, Mariller Marjorie M, Rivlin Michael, Sharma Krishn, Casden Andrew, Bitan Fabian, Kuflik Paul, Neuwirth Michael
Moreno Spine and Scoliosis, Safety Harbor, FL 34695, USA. sjmdbones@ yahoo.com
Spine (Phila Pa 1976). 2008 Oct 1;33(21):2310-5. doi: 10.1097/BRS.0b013e31818047f2.
A retrospective review.
To review the effectiveness of blood conservation techniques in the spinal fusion of patients that refuse blood transfusion; specifically the Jehovah's witnesses population.
Spinal surgery can be challenging in patients refusing blood transfusion. There is paucity in the literature examining blood conservation techniques in spinal surgery.
The radiographic and medical records of 19 Jehovah's witnesses patients who underwent spinal deformity surgery at a single institution between 2000 and 2003 were reviewed. Patients were assessed for excessive blood loss (EBL), deformity correction, operative time, perioperative complications, and hospital stay. At latest follow-up (mean, 40 months; range, 8-76) the patients were examined for radiographic fusion, progression and complications.
Spinal fusion was attempted in 19 patients, with a mean age of 17 years (range, 10-36 years). All 19 patients were identified through the "Bloodless Surgery Program." Hypotensive anesthesia, hemodilution, and cell saver was employed for all 19 cases. Erythropoietin with supplemental iron was used in 15 patients. Aprotinin was used in 3 patients. EBL and blood returned by cell saver averaged 855 and 341 mL, respectively. Operative times average 315 minutes. The average drop in hemoglobin from after surgery was 3.1 g/dL. There were 2 intraoperative complications: (i) transient loss of somatosensory evoked potential/motor evoked potential signals; and (ii) one surgery abandoned due to EBL. The average spinal deformity correction was 58%. There were 3 postoperative complications, none related to their refusal of a transfusion. 17 patients were available for radiographic and clinic follow-up of at least 24 months. All displayed radiographic fusion without progression.
These blood conservation techniques allow satisfactory completion of deformity surgery on those patients not willing to be transfused and without major anesthetic or medical complications.
一项回顾性研究。
评估血液保护技术在拒绝输血患者脊柱融合手术中的有效性；特别是针对耶和华见证会信徒群体。
脊柱手术对于拒绝输血的患者而言具有挑战性。目前关于脊柱手术中血液保护技术的文献较少。
回顾了2000年至2003年间在一家机构接受脊柱畸形手术的19名耶和华见证会信徒患者的影像学和病历记录。对患者的失血过多情况（EBL）、畸形矫正、手术时间、围手术期并发症及住院时间进行评估。在最近一次随访时（平均40个月；范围8 - 76个月），对患者进行影像学融合、进展及并发症检查。
19例患者尝试进行脊柱融合手术，平均年龄17岁（范围10 - 36岁）。所有19例患者均通过“无血手术项目”确定。所有19例均采用了控制性低血压麻醉、血液稀释及血液回收。15例患者使用了促红细胞生成素并补充铁剂。3例患者使用了抑肽酶。EBL及血液回收平均分别为855毫升和341毫升。手术时间平均为315分钟。术后血红蛋白平均下降3.1克/分升。术中出现2例并发症：（i）体感诱发电位/运动诱发电位信号短暂丢失；（ii）1例手术因失血过多而放弃。脊柱畸形平均矫正率为58%。术后出现3例并发症，均与拒绝输血无关。17例患者可进行至少24个月的影像学及临床随访。所有患者均显示影像学融合且无进展。
这些血液保护技术能够使不愿接受输血的患者顺利完成畸形手术，且无重大麻醉或医疗并发症。
