| Japanese |
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| Title | エホバの証人の再弁置換術の麻酔経験 |
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| Subtitle | 症例 |
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| Authors | 前知子*, 野村実*, 長尾薫*, 水口かおる*, 藤田昌雄*, 鈴木英弘*, 小山雄次**, 須麿幸蔵*** |
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| Authors(kana) | |
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| Organization | *東京女子医科大学麻酔学教室, **西新井病院心臓血管外科, ***東京女子医科大学第2病院心臓血管外科 |
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| Journal | 循環制御 |
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| Volume | 15 |
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| Number | 3 |
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| Page | 452-455 |
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| Year/Month | 1994/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」信仰上の理由から輸血を拒否する「エホバの証人」信者に対し, 再弁置換術を無輸血で行ない, 術後良好な経過を得た症例を経験した. 症例は43歳女性で, 20年前に大動脈弁置換術と心室中隔閉鎖術を受けたが, 血栓弁が疑われ再手術が予定された. 術前にエリスロポイエチンを投与し増血を計ったが子宮筋腫からの出血のためヘモグロビン値の増加がみられず, 子宮摘出術を行ったのち, エリスロポイエチンを再投与した. 術中は回収式自己血輸血及び希釈式自己血輸血を, 術後はドレーン血回収式自己血輸血を行なうことで無輸血で軽快退院することができた. このような患者の手術に際しては, エリスロポイエチン, 血液回収装置および血液製剤等が使用可能かどうかを術前に確認し, 出血対策を術前から積極的に行なっておくことが重要である. 「はじめに」エホバの証人(Jehovah's Witness)は, 「ものみの塔Watch Tower」としても知られるキリスト教の一派で全世界に約225万人, 日本には約5万人の信者がいると言われている. 信者は宗教上の理由で血液および血液製剤の投与を拒否するため, 医療行為上支障をきたすことがある. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Jehovah's Witness, Re-AVR, Erythropoietin, Autotransfusion |
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| English |
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| Title | Anesthetic Management of a Patient with Jehovah's Witness Undergoing Re-aortic Valve Replacement |
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| Authors | Tomoko Mae*, Minoru Nomura*, Kaoru Nagao*, Kaoru Mizuguchi*, Masao Fujita*, Hidehiro Suzuki*, Yuji Koyama**, Kouzo Suma*** |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology, Tokyo Women's Medical College Hospital, **Department of Cardiovascular Surgery, Nishiarai Hospital, ***Department of Cardiovascular Surgery, Tokyo Women's Medical College Daini Hospital |
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| Journal | Circulation Control |
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| Volume | 15 |
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| Number | 3 |
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| Page | 452-455 |
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| Year/Month | 1994/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Jehovah's Witness believe that the acceptance of blood or blood products results in forfeiture of the chance for resurrection and eternal salvation. We report a case of a 43 year-old woman with Jehovah's Witness scheduled for a re-aortic valve replacement. To increase preoperative hemoglobin levels, she was given erythropoietin with iron supplements for 11 week preoperatively. Her hemoglobin value increased from 11.8 g/dl to 14.0 g/dl with hematocrit increased from 37.6% to 46.1%. The aortic valve replacement was performed under extracorporeal circulation primed with Ringer's lactate. Although the patient did not accept autotransfusion of blanked blood, we used a Cell Saver(R) for retransfusion, which blood was connected to a peripheral venous line uninterruptedly. Her minimal hematocrit level during extracorporeal circuration was 28% and her hemoglobin value prior to the admission to the ICU was 9.2g/dl (hematocrit of 35.0%). Postoperatively, drained mediastinal blood was returned to the patient and erythropoietin therapy was also continued for 10 days. 37 days later, the patient was discharged from the hospital with a hemoglobin value of 13.0g/dl and hematocrit value of 42.2%. In conclusion, the use of erythropoietin and perioperative autotransfusion are benefical methods in Jehovah's Witnesses who accept blood salvage techiques. |
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| Practice | Basic medicine |
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| Keywords | Jehovah's Witness, Re-AVR, Erythropoietin, Autotransfusion |
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