Department of Surgery, Bronx-Lebanon Hospital Center, New York 10457, USA.
Am J Crit Care. 2011 Mar;20(2):179, 176-8. doi: 10.4037/ajcc2011498.
A 66-year-old woman who was a Jehovah's Witness had massive lower gastrointestinal bleeding and subsequent hypovolemic shock, necessitating a subtotal colectomy. During the postoperative period, her hemoglobin level decreased to a low of 2.6 g/dL, prolonging her dependence on mechanical ventilation. Prudent perioperative care resulted in a successful outcome. Blood-conserving techniques are indispensable in the management of Jehovah's Witnesses who have massive blood loss. Maximizing oxygen transport, minimizing blood loss, using a cell saver when permissible, providing optimal ventilatory support, performing tracheostomy early if prolonged mechanical ventilation is expected, and augmenting hemoglobin production with administration of iron and erythropoietin are techniques that can facilitate successful outcome in patients who refuse blood transfusion.
一位 66 岁的老年妇女，是耶和华见证人，出现大量下消化道出血和随后的低血容量性休克，需要进行次全结肠切除术。术后期间，她的血红蛋白水平下降到低至 2.6 g/dL，延长了她对机械通气的依赖。谨慎的围手术期护理带来了成功的结果。对于大量失血的耶和华见证人，节约用血技术是不可或缺的。最大限度地提高氧输送，最小化失血，在允许的情况下使用血细胞分离机，提供最佳的通气支持，如果预计需要长时间机械通气，则尽早进行气管切开术，以及通过给予铁剂和红细胞生成素来增加血红蛋白生成，这些技术可以促进拒绝输血的患者获得成功的结果。
