「エホバの証人」派の信者に対するACバイパス術の1例

A case of aorto-coronary bypass in Jehovah's Witness

　宗教上の理由により輸血を拒否する「エホバの証人」派の信者に対する医療行為に関しては純医学的な問題とは全く異質な問題が生ずる。心臓手術，とくに体外循環を補助手段として使用する開心術では体外循環回路充填術後出血等において輸血拒否に起因する問題が発生する。最近我々は「エホバの証人」派の信者に対し限外濾過装置と自家血輸注法を併用し無輸血にてACバイパス術を施行したので報告する。

An aorto-coronary bypass grafting was performed in a 50 year-old man, a Jehovah's Witness, suffering from effort angina pectoris. Preoperatively, he was underwent PTCA for LAD occlusion, which failed.

Single aorto-coronary bypass grafting using IMA was performed under the extracorporeal circulation primed with Ringer's Lactate and albumin. Moderate hypothermia with core temperature of 31.5℃ was used, and minimal level of the hematocrit was 18% during the perfusion.

At the start of the operation, 800ml of blood were withdrawn from the jugular vein to the blood bag which connected to a peripheral venous line uninter-ruptedly. During the operation, the autologous blood was continuously transfused very slowly and most of the autologous blood was transfused after the termi-nation of extracorporeal circulation. The blood in the extracorporeal circuit was hemoconcentrated with ECUM (extracorporeal ultrafiltration method) from hematocrit level 22% to 35% and transfused.

The postoperative course was uneventful. At the time of discharge from hospital on the 42 nd post-operative day the hemoglobin level was 13. 1g/dl and hematocrit level was 42%.