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

作　　者：无 康鹏德[4] 黄强[4] 沈慧勇[5] 邵增务[6] 严世贵[7] 向兵 周宗科[4] 黄泽宇[4] 林进[9] 胡懿郃[10] 张卫国[11] 陈允震[12] 徐鹏 张立海[14] 李庭[15] 郭建军[16] 高鹏[9] 吴新宝[15] 唐佩福[14] 牛挺[8] 孙天胜 翁习生[9] 邵宗鸿[18] 邱贵兴[9] 裴福兴[4] 无;KANG Pengde;HUANG Qiang;SHEN Huiyong;SHAO Zengwu;YAN Shigui;XIANG Bing;ZHOU Zongke;HUANG Zeyu;LIN Jin;HU Yihe;ZHANG Weiguo;CHEN Yunzhen;XU Peng;ZHANG Lihai;LI Ting;GUO Jianjun;GAO Peng;WU Xinbao;TANG Peifu;NIU Ting;SUN Tiansheng;WENG Xisheng;SHAO Zonghong;QIU Guixing;PEI Fuxing(Committee of Musculoskeletal Rehabilitation technology Transformation of China Association of Rehabilitation Technology Transformation and Promotion;Joint Diseases Prevention and Treatment Branch of China International Exchange and Promotion Association for Medical and Healthcare;Joint Surgery Committee of Chinese Research Hospital Association;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041;Department of Orthopedics,The Eighth Affiliated Hospital,Sun Yat-Sen University,Shenzhen 518033;Department of Orthopedics,Wuhan Union Hospital,Huazhong University of Science and Technology,Wuhan 430022;Department of Orthopedics,The Second Affiliated Hospi⁃tal of Zhejiang University School of Medicine,Hangzhou 310009;Department of Hematology,West China Hospital,Sichuan University,Chengdu 610041;Department of Orthopedics,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730;Department of Orthopedics,Xiangya Hospital,Central South University,Changsha 410008;Department of Ortho⁃pedics,The First Affiliated Hospital,Dalian Medical University,Dalian 116044;Department of Orthopedics,Qilu Hospital of Shandong University,Jinan 250012;Department of Orthopedics,Red Cross Hospital of Xi'an,Xi'an 710054;Department of Orthopedics,Chinese PLA General Hospital,Beijing 100853;Department of Orthopedics,Beijing Jishuitan Hospi⁃tal,Beijing 100035;National Sport and Medicine Integration Center,Beijing 100061;Department of Orthopedics,The Seventh Medical Center of PLA General Hospital,Beijing 100700;Department of Hematology,General Hospital,Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]中国康复技术转化及发展促进会肌肉骨骼运动康复技术转化专业委员会 [2]中国医疗保健国际交流促进会骨科分会关节学组 [3]中国研究型医院学会关节外科学专业委员会 [4]四川大学华西医院骨科,成都610041 [5]中山大学附属第八医院骨科,深圳518033 [6]华中科技大学同济医学院附属协和医院骨科,武汉430022 [7]浙江大学医学院附属第二医院骨科,杭州310009 [8]四川大学华西医院血液科,成都610041 [9]中国医学科学院北京协和医学院北京协和医院骨科,北京100730 [10]中南大学湘雅医院骨科,长沙410008 [11]大连医科大学附属第一医院骨科,大连116044 [12]山东大学齐鲁医院骨科,济南250012 [13]西安市红会医院骨科,西安710054 [14]解放军总医院骨科,北京100853 [15]北京积水潭医院骨科,北京100035 [16]国家体育总局体育科学体医融合促进与创新研究中心,北京100061 [17]解放军总医院第七医学中心,北京100700 [18]天津医科大学总医院血液科,天津300052

出　　处：《中华骨与关节外科杂志》2019年第11期833-840,共8页Chinese Journal of Bone and Joint Surgery

摘　　要：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.

关 键 词：骨科手术 贫血 围手术期 诊断 治疗 

分 类 号：R73[医药卫生—肿瘤]