Sculco Peter K, Pagnano Mark W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2015 Apr;30(4):518-20. doi: 10.1016/j.arth.2015.01.036. Epub 2015 Jan 30.
Rapid recovery after total joint arthroplasty requires patients to get ahead and stay ahead or the four impediments to early rehabilitation and discharge: volume depletion, blood loss, pain, and nausea. Adequate volume resuscitation starts before entering the operating room and focuses on intravenous fluids rather than red blood cell transfusion. Tranexamic acid limits blood loss and reduces the need for most other blood management systems. Rapid recovery pain management focuses on minimizing parenteral opioids. A short-acting spinal with a peri-articular local anesthetic injection is reliable, reproducible, and safe. Patients at risk for post-operative nausea are treated with anti-emetic medications and perioperative dexamethasone. These interventions reflect a transition from the sick-patient model to the well-patient model and make rapid recovery joint arthroplasty a reality in 2015.
血容量减少、失血、疼痛和恶心。充分的容量复苏在进入手术室之前就开始，并且侧重于静脉输液而非红细胞输血。氨甲环酸可减少失血并降低对大多数其他血液管理系统的需求。快速康复疼痛管理侧重于尽量减少胃肠外阿片类药物的使用。联合关节周围局部麻醉注射的短效脊髓麻醉可靠、可重复且安全。有术后恶心风险的患者使用止吐药物和围手术期地塞米松进行治疗。这些干预措施反映了从患病患者模式向健康患者模式的转变，并使快速康复关节置换术在2015年成为现实。
