Expert consensus in enhanced recovery after orthopedic surgery in China: perioperative blood management

骨科手术出血量大、异体输血率高,骨科手术患者术前及术后贫血的发生率高.围术期贫血增加术后感染风险,延长住院时间,影响术后功能康复和生活质量;异体输血存在输血相关不良反应风险,增加血液资源紧张局面及患者医疗负担.因此,加强骨科大手术围术期血液管理(perioperative blood management,PBM)是实施加速康复的重要环节.通过查阅文献,基于国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组数据库大样本数据分析,遵循循证医学原则,经过全国专家组反复讨论,针对临床骨科大手术患者围术期血液管理达成共识,供广大骨科医师在临床工作中参考应用.围术期血液管理是指在围术期的各个阶段采取多种技术进行血液质和量的保护,以减少失血、降低贫血及输血率,提高手术安全性和医疗质量,增加患者满意度.其主要内容包括:术前术后优化造血、术中减少出血、提高患者贫血耐受性及合理异体输血.Patients with orthopeadic surgery usually suffer from large blood loss and high incidence of transfusion and pre-operative and postoperative anemia. Perioperative anemia will increase the rate of infection, prolong the length of hospital stay, and affect function recovery and life quality. Allogeneic transfusion will increase the incidence of complications related to transfusion, the tension of blood resource and medical burden. Therefore, perioperative blood management (PBM) of or-thopedic surgery is an important step in enhanced recovery after surgery (ERAS). Based on literatures and expert group dis-cussion combined with the database of the project group for the"National Health and Family Planning Commission's public-benefit project:the safety and effect assessment of joint arthroplasty"and evidence-based medicine, we compile this consen-sus which mainly contains perioperative optimization of hematopoiesis, decrease of blood loss, improvement of tolerance of patients with anemia and reasonable allogeneic transfusion. We aim to decrease the blood loss and incidence of anemia and transfusion, improve the safety of surgery and medical quality and patients' satisfaction through PBM in the perioperative pe-riod of orthopedic surgery. Also, we hope that this consensus would give some help to orthopedic surgeons.11-71