Sculco Thomas P, Baldini Andrea, Keating E Michael
Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA.
Instr Course Lect. 2005;54:51-66.
One of the primary goals in the perioperative care of orthopaedic patients undergoing surgery is the avoidance of allogeneic transfusion. There are a number of ways to lessen blood loss during surgical intervention including regional hypotensive anesthesia, careful and atraumatic surgical technique, and coagulation of bleeding surfaces. Achieving coagulation is difficult in spinal and arthroplasty procedures because of the large cancellous surfaces that are vascular and are not amenable to ligature or thermal coagulation. All measures of autologous blood salvage should be used including preoperative deposit of autologous blood, hemodilution techniques, intraoperative salvage (when appropriate), and postoperative retrieval and reinfusion. The use of perioperative recombinant erythropoietin is also a useful adjunct to promote stimulation of the bone marrow and increased red cell production. Although many infectious diseases that are transmitted through allogeneic blood transfusions have been lessened by better screening techniques, there is still potential life threatening reactions and viral transmissions that may be avoided by comprehensive blood management in joint arthroplasty.
接受手术的骨科患者围手术期护理的主要目标之一是避免异体输血。在手术干预期间，有多种方法可减少失血，包括区域低血压麻醉、仔细且无创的手术技术以及对出血表面进行凝血。在脊柱和关节置换手术中，由于存在大量血管丰富且不适合结扎或热凝的松质骨表面，实现凝血很困难。应采用所有自体血回输措施，包括术前自体血储存、血液稀释技术、术中回收（如适用）以及术后回收和回输。围手术期使用重组促红细胞生成素也是促进骨髓刺激和增加红细胞生成的有用辅助手段。尽管通过更好的筛查技术减少了许多通过异体输血传播的传染病，但在关节置换术中，通过全面的血液管理仍可避免潜在的危及生命的反应和病毒传播。
