华西医院骨科关节置换术加速康复围手术期血液管理临床实践及成效  

Clinical practice and effect of perioperative blood management for enhanced recovery after surgery of the department of orthopedics of West China Hospital

作　　者：曾伟南[1] 杨静[1] 沈彬[1] 康鹏德[1] 裴福兴[1] 周宗科[1] ZENG Wei-nan;YANG Jing;SHEN Bin;KANG Peng-de;PEI Fu-xing;ZHOU Zong-ke(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《川北医学院学报》2021年第9期1175-1180,共6页Journal of North Sichuan Medical College

摘　　要：目的:探讨加速康复围手术期血液管理策略在我科关节置换术患者的临床实践及成效。方法:全面分析总结四川大学华西医院骨科关节置换术患者术前、术中及术后开展的血液管理策略,并分析取得的相关成效。结果:目前我科髋、膝关节置换术患者围手术期血液管理策略主要包括:术前优化造血及治疗贫血、术中减少出血及术后治疗贫血及合理输血。其中术前包括患者贫血原因筛查及治疗等;术中包括优化手术操作技术、控制性降压、氨甲环酸使用及血液回输等;术后包括冰敷和加压包扎、氨甲环酸使用,贫血纠正,合理输血等。通过以上管理策略的实施,我科髋、膝关节置换术患者围手术期血红蛋白水平得到持续提升,输血率明显降低,节约大量血源。目前髋、膝关节置换术患者围手术期输血率已降至0.8%以下,取得令人满意的效果。结论:我科髋、膝关节置换术围手术期血液管理策略取得了良好的成效,为骨科手术围手术期血液管理进一步优化提供参考。Objective:To evaluate the clinical practice and effects of the perioperative blood management for enhanced recovery after surgery in our department.Methods:To analyze the preoperative,intraoperative and postoperative blood management strategies and the results achieved on patients who undergoing hip and knee arthroplasty in the Department of Orthopedics of West China Hospital.Results:The blood management strategies for patients who received THA or TKA in our department mainly include:preoperative,intraoperative and postoperative blood management strategies.The preoperative blood management strategies including:optimize hematopoiesis,and treat anemia,the intraoperative blood management strategies including:improving surgical techniques,intraoperative use of tranexamic acid,controlled hypotension and blood doping,and postoperative blood management strategies including:postoperative use of tranexamic acid,treat anemia,rational transfusion,pressure dressing and ice compress.By the implementation of the above management strategies,the perioperative hemoglobin level was continuously improved and the blood transfusion rate was persisting declined in recent years.The blood transfusion rate was dropped below 0.8%,satisfactory results had been achieved.Conclusion:Satisfactory blood management results have been achieved on patients who received THA or TKA in our department which can be expected to provide reference for the further improvement of perioperative blood management.

关 键 词：华西医院骨科 人工全髋关节置换术 人工全膝关节置换术 血液管理 

分 类 号：R687.4[医药卫生—骨科学] R457.1[医药卫生—外科学]