中国骨科手术围手术期贫血诊疗指南

Guidelines for diagnosis and treatment of anemia during perioperative period of orthopedic surgery in China

贫血是骨科患者围手术期常见的并存疾病,发生率为12.8%~45.0%。术前贫血常见原因有营养不良、慢性失血性疾病、肿瘤、自身免疫性疾病、慢性感染或创伤等;手术导致的显性和隐性失血术后又将加重贫血。术后贫血造成细胞、组织、器官缺血缺氧,增加输血率、感染风险、致残率及死亡率,易引发血液传播疾病并影响免疫功能,延缓术后康复,延长住院时间。术前明确贫血病因及贫血类型是治疗贫血的关键。骨科手术围手术期常见贫血类型有缺铁性贫血、正细胞正血色素贫血、大细胞型贫血等。平均红细胞体积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)、血清铁(SI)水平、血清铁蛋白(SF)水平、总铁结合力(TIBC)等检测可明确贫血类型。贫血治疗包括术前积极处理原发病、消除病因、加强营养、提高血红蛋白水平,术中微创操作、控制性降压、应用氨甲环酸减少出血、减少手术失血的应激反应,围手术期铁剂联合应用促红细胞生成素(EPO)加快提升血红蛋白水平及减少术后异体输血等,必要时联合血液科医师共同诊治,促进患者早期康复,降低或避免并发症发生。

Anemia is a common comorbid disease in orthopedic patients,with an incidence ranging from 12.8%to 45.0%.The common causes of preoperative anemia contain malnutrition,chronic blood loss,cancer,autoimmune disease,chronic infection and trauma.If preoperative anemia cannot be corrected,the condition would aggravate in addition to the surgical trauma,dominant and hidden blood loss caused by the surgery.Postoperative anemia would lead to ischemia and hypoxia of cells,tissues and organs,which increase transfusion rate,infection risk,morbidity and mortality,easily cause blood-borne diseases,affect immune function,delay postoperative recovery and prolong hospital stay.The key point of anemia treatment is to find out the cause and type of anemia before operation.Common types of anemia during the perioperative period of orthopedic surgery include iron deficiency anemia,positive cell hemoglobin anemia,and large cell anemia.Mean red blood cell volume(MCV),mean red blood cell hemoglobin(MCH),mean red blood cell hemoglobin concentration(MCHC),serum iron(SI),serum ferritin(SF),total iron binding capacity(TIBC)were used to determine the anemia type.Based on the diagnosis and anemia type,surgeons can take measures such as actively treating the primary disease,eliminating the cause,reinforcing nutrition,and improving hemoglobin level before surgery,performing minimally invasive operation,controlled hypotension,tranexamic acid application,autologous blood absorption,and reducing stress reaction caused by blood loss during surgery,perioperative iron and erythropoietin,and allogeneic blood transfusion.If necessary,MDT was given to correct anemia.By doing these,we can promote early recovery,reduce or avoid the occurrence of complications.