Tenholder Mark, Cushner Fred D
Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY, USA.
Orthopedics. 2004 Jun;27(6 Suppl):s663-8. doi: 10.3928/0147-7447-20040602-07.
Interest is growing in blood conservation and avoidance of transfusion in patients undergoing orthopedic surgery, especially in the field of joint replacement. Several methods have proven successful in reducing intraoperative blood loss, which can translate into lessened allogeneic and autologous transfusion requirements. Available techniques include acute normovolemic hemodilution, hypotensive anesthesia, intraoperative blood salvage, specialized cautery, topical hemostatic agents, and pharmacologic agents given in the perioperative period. The greatest potential benefit arises in operations with greater expected blood loss or in special situations such as in patients with religious issues, bilateral joint replacement, coagulation disorders, or significant preoperative anemia.
骨科手术患者，尤其是关节置换领域的患者，对血液保护和避免输血的关注度日益增加。已证实几种方法在减少术中失血方面是成功的，这可转化为减少异体和自体输血需求。可用技术包括急性等容血液稀释、控制性低血压麻醉、术中血液回收、专用电灼、局部止血剂以及围手术期给予的药物。在预期失血较多的手术中或在特殊情况下，如存在宗教问题的患者、双侧关节置换、凝血障碍或术前严重贫血的患者，潜在益处最大。
