骨科加速康复围手术期血液管理专家共识

Expert consensus on perioperative blood management in orthopaedics in enhanced recovery after surgery program

骨科手术较高的术前贫血发生率、术中出血量及术后异体输血率是阻碍患者功能康复的主要问题,做好围手术期血液管理是骨科加速康复的关键技术。为了进一步加强骨科加速康复围手术期血液管理在临床的应用、提高医疗质量和安全,国家卫生健康委加速康复外科专家委员会骨科专家组、中国研究型医院学会骨科加速康复专业委员会、中国康复技术转化及促进会骨科加速康复专业委员会联合相关学科专家成立骨科加速康复系列共识编写专家委员会,以临床问题为导向、遵循循证医学原则,归纳出4个方面的问题:(1)术前血液管理(术前贫血筛查与治疗、创伤骨科患者术前血液管理、术前预存自体输血、术前血小板减少症的诊疗);(2)术中血液管理(微创理念优化手术操作、控制性降压、应用氨甲环酸、自体血液回输、特殊技术、术中贫血监测);(3)术后血液管理(术后贫血监测、术后出血及止血、术后贫血的预防与治疗);(4)围手术期单病种手术输血评估机制。按照上述4个方面的问题进行文献检索和归纳,结合2017版《中国骨科手术加速康复——围术期血液管理专家共识》及近5年国内外最新研究进展,更加细化了术前、术中、术后的血液管理措施与择期手术围手术期单病种手术输血评估机制。经过反复讨论和修改后形成本共识,期望其为我国骨科加速康复围手术期血液管理的多学科协作起到积极的推动作用,最终达到加速患者康复的目的。

The high incidence of preoperative anemia,intraoperative blood loss and postoperative allogeneic blood transfusion rate in orthopaedic surgery are the main problems that hinder the functional rehabilitation of patients.Perioperative patient blood management(PBM)is the key to accelerate the implementation and promotion of the concept of enhanced recovery after surgery.In order to further refine the perioperative PBM of orthopaedic surgery and improve medical quality and safety,Orthopaedic Expert Group of ERAS profession Committee of National Health Commission,Orthopaedic ERAS profession Committee of Chinese Research Hospital Association,Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion,together with experts from other relevant disciplines,established a collaborative expert committee for this consensus writing.Focusing on the clinical problems and following evidence-based medicine principles,the experts summarized the following four aspects:(1)preoperative PBM(preoperative anemia screening and treatment,preoperative blood loss prevention and correction of preoperative acute anemia for patients with orthopaedic trauma,pre stored autologous blood transfusion,diagnosis and treatment of preoperative thrombocytopenia);(2)intraoperative PBM(minimally invasive concept involved operation technique,controlled blood pressure reduction,tranexamic acid application,autoblood recycle,anemia monitoring and other special technology);(3)postoperative PBM(anemia monitoring,bleeding and hemostasis,prevention and treatment of anemia);(4)evaluation of transfusion for single disease.Around these four aspects,literature was searched and induced,and the latest researches of recent five years were referenced as well as the 2017 edition of Expert consensus in enhanced recovery after orthopaedic surgery in China:perioperative blood management.Through repeated discussions and revisions,this consensus was developed,which was refined at blood management measures during preoperative,intraoperative and postoperative periods as well as evaluation of blood transfusion for single disease,hoping to promote the multidisciplinary cooperation and realize rapid recovery for patients.