全膝关节置换术围术期血液管理的研究进展

Research advances on perioperative blood management for total knee arthroplasty

全膝关节置换术后常并发急性失血性贫血。异体输血是目前纠正术后贫血的主要措施，虽然可以快速纠正贫血，但可能引起各种严重的并发症及其他问题，包括感染、肢体康复时间延长、住院时间延长、死亡率增加等。全膝关节置换术围术期采取血液管理措施可有效降低术后失血，减少或避免异体输血。围术期血液管理措施主要分为三部分：术前纠正贫血、自体血储存；术中止血带、抗纤溶药、局部止血剂、急性等容性血液稀释等的应用；术后自体血回输、遵循输血指征、处理引流和体位控制等。围术期血液管理旨在减少术后失血、降低输血率、改善预后、促进术后康复及降低医疗成本。血液管理理念必须贯穿整个围手术期，临床医生需要根据患者实际情况，结合不同血液管理方法的特点，权衡利弊，制定出高效合理的个体化治疗方案。

Acute blood loss anemia is the most common surgical complication of total knee arthroplasty. Currently, allogeneic transfusion has been the major method of managing postoperative anemia. Although allogeneic transfusion can correct anaemic condition temporarily, it can lead to severe complications, such as postoperative infection, prolongation of physical recovery, increased length of hospital stay, and increased mortality. Perioperative blood management can effectively reduce blood loss and transfusion rate. These strategies mainly focus on three parts： therapy for anemia and autologous blood donation before operation; application of a tourniquet, antifibrinolytic drugs, topical hemostatic agents and acute normovolemic hemodilution during operation; selection of reinfusion systems, restrictive transfusion thresholds, drainage and knee position after operation. Perioperative blood management should run throughout the perioperative period, which mainly aims at reducing blood loss and blood transfu- sion, improving prognosis, promoting the postoperative recovery and lowering the medical cost. Depending on the actual situations of patients, surgeons should combine different major characteristics of each strategy and weigh the pros and cons to make effective and reasonable individualized treatment plan.