人工关节置换术围手术期的血液管理策略

PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY

目的综述人工关节置换术围手术期血液管理策略。方法查阅近年国内外相关文献,对人工关节置换术前、术中及术后血液管理相关研究进行总结分析。结果目前人工关节置换围手术期血液管理方式较多,其中术前包括补充铁剂、使用促红细胞生成素和自体血储备,术中包括急性等容血液稀释技术、抗纤溶治疗、使用止血带等,术后包括使用自体血回输系统以及严格的输血指征。对贫血患者,术前单独使用促红细胞生成素或者联合自体血储备可以降低术后输血率,术中使用止血带及静脉输注氨甲环酸也能有效控制术中出血,术后采取严格的输血指征可有效减少不必要的输血。结论人工关节置换术围手术期血液管理应针对患者个体情况综合使用多种方式,减少围手术期失血及输血,促进患者康复。

Objective To summarize the perioperative blood management strategies for joint arthroplasty. Methods The literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. Results At present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin （EPO）, and preoperative autologous donation （PAD）. Intraoperative options include acute normovolemic hemodilution （ANH）, antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. Conclusion Perioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.