Moonen A F C M, Neal T D, Pilot P
Department of Orthopaedic Surgery, Atrium MC, Heerlen, The Netherlands.
Injury. 2006 Dec;37 Suppl 5:S11-6. doi: 10.1016/S0020-1383(07)70006-2.
Blood loss during orthopaedic procedures can be extensive and the need for allogeneic blood is a common requirement. However, blood transfusion conceals a number of well-recognised risks and complications and blood products have become more expensive because of their specific preparation procedure. Surgical technique, awareness of the problem and restriction of transfusion triggers are important factors affecting the management of blood loss. Several studies have additionally shown the efficacy of epoetin injections in increasing the pre-operative haemoglobin level. On the other hand, the true benefit of pre-operative autologous donation, acute normovolemic haemodilution and COX-2 selective NSAIDs remains under dispute. Regarding the role of platelet rich plasmapheresis, fibrin sealing and anti-fibinolytic drugs more data are needed. Hypotensive epidural anaesthesia seems to be an advantageous method in minimising peri-operative blood loss. However, this is not a widely performed technique in orthopaedic surgery. In addition, post-operative blood cell saving systems after total knee or hip arthroplasty have been reported to significantly minimise allogeneic blood transfusions when compared to control groups. It can be concluded that many interventions diminish more or less allogeneic blood transfusion in elective orthopaedic surgery. Nevertheless more prospective studies are needed and appropriate algorithms should be applied in peri-operative blood loss management. This review presents an overview of the available interventions which aim to diminish the use of allogeneic blood in elective orthopaedic surgery.
骨科手术中的失血量可能很大，因此通常需要输注异体血。然而，输血存在一些公认的风险和并发症，并且由于血液制品的特殊制备程序，其价格也变得更加昂贵。手术技术、对问题的认识以及对输血触发因素的限制是影响失血管理的重要因素。多项研究还表明，促红细胞生成素注射剂在提高术前血红蛋白水平方面具有疗效。另一方面，术前自体献血、急性等容性血液稀释和COX-2选择性非甾体抗炎药的真正益处仍存在争议。关于富血小板血浆置换、纤维蛋白封闭和抗纤溶药物的作用，还需要更多数据。低血压硬膜外麻醉似乎是减少围手术期失血的一种有利方法。然而，这在骨科手术中并不是一种广泛应用的技术。此外，据报道，与对照组相比，全膝关节或髋关节置换术后的血细胞回收系统可显著减少异体输血。可以得出结论，许多干预措施或多或少地减少了择期骨科手术中的异体输血。尽管如此，仍需要更多的前瞻性研究，并应在围手术期失血管理中应用适当的算法。本综述概述了旨在减少择期骨科手术中异体血使用的现有干预措施。
