Banerjee Samik, Kapadia Bhaveen H, Issa Kimona, McElroy Mark J, Khanuja Harpal S, Harwin Steven F, Mont Michael A
Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
J Knee Surg. 2013 Dec;26(6):395-400. doi: 10.1055/s-0033-1357491. Epub 2013 Oct 11.
Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.
在下肢全关节置换术中，失血是一个严重问题，据估计全膝关节置换术（TKA）后血红蛋白浓度降低2至4 g/dL。异体输血通常用于治疗急性失血和术后贫血，以降低高达50%的大量失血病例中的潜在心血管风险。然而，这些输血与免疫反应、免疫抑制和感染传播风险相关。已经开发了多种血液保护策略，以尽量减少失血、降低输血率、减少并发症并改善术后结果。目前，对于为减少与TKA相关的失血而采用的血液管理策略尚无明确指南。本研究的目的是回顾文献，并对目前术后使用的几种血液保护措施的疗效和并发症进行广泛总结。有证据表明，诸如肢体抬高、冷冻疗法、加压包扎和引流管夹闭等简单技术可能会减少外部引流，然而，这些技术是否会减少异体输血目前仍有争议。需要对这些策略的联合使用及其成本效益进行进一步研究。
