石伟发　尹东　黄文文

[摘要]全髋关节置换术患者常因术前贫血、术中及术后的失血，并发术后急性贫血。急性贫血若不及时进行输异体血，会导致患者生命征不平稳或者延迟康复。进行输异体血虽可以平稳生命征，但有可能发生发热、过敏等输血并发症或者感染率、住院日、死亡率增加等其他问题。快速康复外科理念应用于髋关节置换术围术期患者的管理，在不增加并发症的基础上，促进患者早期康复。失血成为影响快速康复的生理干扰之一，应用快速康复外科理念对全髋关节置换患者围术期包括术前、术中、术后的血液管理，如节约、再利用自体血，以减少术后失血，减少异体血输入，减少住院日、促进患者早期康复，增加患者满意度及舒适度。

[关键词]快速康复外科；全髋关节置换术；血液管理

[中图分类号] R684.3 [文献标识码] A [文章编号] 1674-4721（2017）07（b）-0011-06

[Abstract]Acute anemia is often the most common complication after hip arthroplasty，because the patient is suffering anemia before operation，and blood loss intraoperative and postoperative.The vital sign of patients will become unstable or the proceedings of rehabilitation may delay due not to given a blood transfusion.Although allogeneic transfusion，making vital sign steady，may lead to severe transfusion complications，such as having a fever，irritability and so on，or other complications which the rate of infection，length of stay，mortality may increase.The theory of fast-track surgery which is base on no additional complications applies to the management period of total hip replacementin perioperative period，makes the patients have physical training early.Bloodloss，being one of obstructions，will slow the fast-track of patient down.The blood management of total hip replacement including preoperative intraoperative，ostoperative，such as blood saving，recycle applies to the theory of fast-track surgery to reduce postoperative blood loss，reduce blood transfusion，reduce length of stay，promote the patient early rehabilitation increases patient satisfaction and comfort.

[Key word]Fast-track surgery；Total hip arthroplasty；Blood management

随着老年化社会的推进及诊疗技术提高，越来越多髋关节疾病得到确诊，然而全髋关节置换术（total hip arthroplasty，THA）已经发展为一项成熟的技术，并给老年人股骨颈骨折、终末期髋关节骨性关节炎、股骨头坏死（包括酒精性、激素性、免疫性等因素）[1-2]等髋部疾病的患者带来福音，重建了患侧髋关节功能，恢复患者行走功能。但由于术前贫血、术中失血及术后伤口渗血会造成行THA患者术后急性失血性贫血，Torres-Gomez等[3]和Wu等[4]曾报道THA后圍术期患者失血量在700～2000 ml，Stanworth等[5]也报道37%～90%骨科术后患者平均需要输入两单位异体血。但是输异体血也带来诸多并发症如髋关节感染增加、住院日延长、病死率增加等[6-7]。……