骨科加速康复围术期患者血液管理进展:现状与未来  

Advances in perioperative patient blood management with enhanced recovery in orthopedics:current situation and future prospects

作　　者：谢锦伟[1] 廖刃[2] 向兵 黄强[1] 黄泽宇[1] 周宗科[1] 沈彬[1] 康鹏德[1] 杨静[1] 马俊[1] 胡雯[4] 刘斌[2] 牛挺[3] 裴福兴[1] XIE JinWei;LIAO Ren;XIANG Bin;HUANG Qiang;HUANG ZeYu;ZHOU ZongKe;SHEN Bin;KANG PengDe;YANG Jing;MA Jun;HU Wen;LIU Bin;NIU Ting;PEI FuXing(Department of Orthopedic Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Departmetn of Anesthesiology,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Hematology,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Clinical Nutrition,West China Hospital of Sichuan University,Chengdu 610041)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院麻醉科,成都610041 [3]四川大学华西医院血液科,成都610041 [4]四川大学华西医院临床营养科,成都610041

出　　处：《中国科学：生命科学》2022年第11期1704-1714,共11页Scientia Sinica(Vitae)

摘　　要：血液是生命之源,是保障正常生命活动的关键.骨科患者失血多,创伤失血后手术再失血更是雪上加霜;严重失血会影响机体器官功能,增加严重并发症发生率和术后死亡率.围术期患者血液管理是骨科加速康复发展的核心关键技术之一,是实现骨科加速康复的先决条件.围术期患者血液管理的关键技术需要多学科协作、共同研究,才能推动骨科加速康复的发展.骨科加速康复围术期患者血液管理的关键技术包括:(1)加强围术期患者贫血的诊断与治疗,提升患者血红蛋白水平,建立患者机体血库,是减少输血的基础,从而真正做到围术期患者血液管理的“开源”;(2)采用先进的综合措施,特别是抗纤溶药氨甲环酸的研究与应用,减少术中、术后出血与输血,从而真正做到围术期患者血液管理的“节流”;(3)减少术后出血与加强术后贫血的诊治,同时序贯抗凝预防深静脉血栓形成,逐步达到纤溶与凝血的平衡,从而真正做到既减少失血,也不增加深静脉血栓形成;(4)建立骨科择期手术单病种输血评价机制,逐步优化围术期患者血液管理措施,从而持续提升血液管理能力.骨科加速康复围术期患者血液管理将逐步达到减少因出血、纤溶、凝血紊乱所导致的并发症,实现少输血或无输血手术和患者加速康复的目标,推动医院高质量发展.Blood is the essence of life and plays a crucial role in ensuring the normal functioning of organs.During orthopedic surgery,a large volume of blood loss is inevitable;moreover,it is worse in surgeries after traumas,which could affect the function of vital organs and increase the incidence of serious complications and postoperative mortality.Perioperative patient blood management is one of the key components and a prerequisite for enhanced recovery after orthopedic surgery.Multidisciplinary cooperation is needed to examine the key technique of perioperative patient blood management and thus promote the development of enhanced recovery programs in orthopedics.The key techniques of perioperative patient blood management in orthopedics included the following:(1)strengthening the diagnosis and treatment of preoperative anemia,increasing the hemoglobin level,and establishing self-blood banks for patients,which are the basis for reducing blood transfusion to achieve“Kai Yuan”of patient blood management,(2)adopting advanced comprehensive measures,particularly research and application of antifibrinolytic drug tranexamic acid to reduce intraoperative and postoperative bleeding and blood transfusion,thus achieve the“Jie Liu”of patient blood management,(3)reducing postoperative bleeding,treating postoperative anemia,and keeping the balance between fibrinolysis and coagulation to reduce blood loss and occurrence of deep venous thrombosis,and(4)establishing transfusion evaluation mechanism in elective orthopedic surgery.Thus,perioperative patient blood management in enhanced recovery after orthopedic surgery will gradually reduce complications caused by bleeding,fibrinolysis,and coagulation.Moreover,it will eventually achieve the goal of less or no blood transfusion surgery and accelerated rehabilitation and promote further development of the hospital.

关 键 词：骨科加速康复 围术期 血液管理 关键技术 机体血库 单病种输血评价 

分 类 号：R687.3[医药卫生—骨科学]