Hardesty Douglas A, Doerfler Sean, Sandhu Sukhmeet, Whitmore Robert G, Ford Patricia, Rushton Scott, LeRoux Peter D
Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Lahey Hospital and Medical Center, Peabody, Massachusetts, USA.
World Neurosurg. 2017 Jan;97:132-139. doi: 10.1016/j.wneu.2016.09.028. Epub 2016 Sep 15.
Jehovah's Witnesses (JW) are a Christian faith with >1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program.
Sixty-eight JW patients including 23 men and 45 women (mean age 53 ± 12 years) who underwent a variety of cranial (n = 19) and spinal (n = 49) neurosurgical procedures during a 5-year period were identified retrospectively and their hospital charts, anesthetic records, and operative reports reviewed. A concurrent cohort of sex-, age-, and procedure-matched non-JW controls also was identified.
Among JW patients, a cell-saving system was used in 27 cases, with blood retransfused in 13 cases. Lactated Ringers solution was used extensively intraoperatively; albumin was given to 15 patients. The median decrease in hemoglobin was 2.1 g/dL. One patient had a postoperative hemoglobin value <7 g/dL. One patient returned to the operating room to revise a lumbar pedicle screw, and one patient had postoperative seizures. No cardiopulmonary complications, sepsis, pneumonia, or wound infection were observed. Compared with the matched control group, similar outcome results were observed. Blood loss and operative time also were similar in JW patients and controls.
Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood-management program.
耶和华见证人是一个基督教教派，在美国有超过100万成员，他们不接受自体输血。对于接受神经外科手术的这些患者，最佳管理方案尚不明确。在此，我们研究了耶和华见证人在血液管理方案下接受神经外科手术的可行性和安全性。
回顾性确定了68例耶和华见证人患者，包括23名男性和45名女性（平均年龄53±12岁），他们在5年期间接受了各种颅脑（n = 19）和脊柱（n = 49）神经外科手术，并查阅了他们的医院病历、麻醉记录和手术报告。同时还确定了一组性别、年龄和手术匹配的非耶和华见证人对照组。
在耶和华见证人患者中，27例使用了细胞回收系统，13例进行了血液回输。术中广泛使用乳酸林格氏液；15例患者给予了白蛋白。血红蛋白的中位数下降为2.1 g/dL。1例患者术后血红蛋白值<7 g/dL。1例患者返回手术室进行腰椎椎弓根螺钉翻修，1例患者术后发生癫痫。未观察到心肺并发症、败血症、肺炎或伤口感染。与匹配的对照组相比，观察到了相似的结果。耶和华见证人患者和对照组的失血量和手术时间也相似。
在多学科血液管理方案下，耶和华见证人患者进行神经外科手术是可行、安全的，并且与愿意接受输血的患者有相似的结果。
