Repair of hypoplastic left heart syndrome of a 4.25-kg Jehovah’s witness
Repair of hypoplastic left heart syndrome of a 4.25-kg Jehovah’s witness
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4.25公斤重的耶和华见证人左心发育不全综合症的修复
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
C. Clark
中科院分区：
文献类型：
--
作者：
R. Forest;R. Groom;R. Quinn;J. Donnelly;C. Clark
对拒绝同种异体输血的患者的护理向心脏外科团队提出了挑战，要求他们改进血液保存技术，并质疑标准的输血做法。我们照顾了一名患有左心发育不良综合征(HLHS)的新生儿，他的父母拒绝同意护理涉及输血的孩子。诺伍德第一阶段手术是在可能的情况下避免输血的情况下计划的。获得了一项法院命令，规定了主治医生为新生儿输血的条件。患者出生时体重为4.25公斤。低质量的体外循环(CPB)电路和积极的血液保护技术，包括改进的超滤(MUF)，使手术的修复和CPB部分无需使用血液即可完成。体外循环期间最低红细胞压积为20%。在尝试脱离体外循环失败后，输血。在Norwood I期之后，HLHS患者的恢复情况是一致的。然而，在术后1个月，患者因肺循环过度而需要减少分流。诺伍德二期修复在4个月大时完成，没有供体血液。手术成功的关键是外科医生、麻醉师和输液师深思熟虑的计划。该计划应包括仔细监测患者的氧合情况和心血管状况。
The care of patients who refuse homologous transfusions has challenged cardiac surgery teams to refine blood conservation techniques and question standard trans-fusion practices. We cared for a newborn child with hypoplastic left heart syndrome (HLHS) whose parents refused to give consent to care for the child that involved the transfusion of homologous blood. A Norwood Stage I procedure was planned with the understanding that transfusions would be avoided, if possible. A court order was obtained that specified the conditions under which the attending physicians would transfuse the newborn. The birth weight of the patient was 4.25 kg. A low prime cardiopulmonary bypass (CPB) circuit and aggressive blood conservation techniques that included modified ultrafiltration (MUF) allowed the completion of the repair and CPB portion of the operation without the use of blood. The lowest hematocrit during CPB was 20%. After an unsuccessful attempt to separate from CPB, blood was transfused. Recovery was consistent for HLHS patients following Norwood Stage I. However, at 1 month postoperatively, the patient did require a shunt reduction for pulmonary overcirculation. Norwood Stage II repair was completed at age 4 months without donor blood. The key to a successful outcome is a well-thoughtout plan by the surgeon, anesthesiologist and perfusionist. This plan should include careful monitoring of the patient’s oxygenation and cardiovascular status.
心血管手术的输血指南：耶和华见证人手术的经验教训。
影响因子：
4.3
作者：
Spence,RK;Alexander,JB;DelRossi,AJ;Cernaianu,AD;CilleyJr,J;Pello,MJ;Atabek,U;Camishion,RC;Vertrees,RA
通讯作者：
Vertrees,RA