Lu Qiang, Peng Hao, Zhou Guan-Jin, Yin Dong
Department of Orthopaedics, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Orthopaedics, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Orthop Surg. 2018 Feb;10(1):8-16. doi: 10.1111/os.12361. Epub 2018 Feb 9.
Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.
全膝关节置换术（TKA）常导致大量失血，同时血红蛋白下降，并可能增加异体输血率。不幸的是，异体输血存在相关风险，包括术后意识模糊、感染、心律失常、液体超负荷、住院时间延长和死亡率增加。除了减少输血需求外，减少TKA围手术期失血还可使关节内出血、肢体肿胀和术后疼痛降至最低，并增加术后早期的活动范围。这些益处可提高康复成功率并提高患者术后满意度。术前贫血，加上术中和术后失血，是TKA输血率较高的主要相关因素。因此，治疗术前贫血和预防围手术期失血是TKA围手术期血液管理的主要策略。本综述结合当前证据，从有效性、安全性和成本方面分析了各种血液保护方法，包括术前、术中和术后方法。由于可以控制许多因素来减少TKA中的失血和输血率，因此可以构建一种高效、安全且具有成本效益的血液管理策略，以消除与TKA相关的输血需求。
