摘要
骨科手术出血量大,异体输血率高,极大增加了患者围手术期并发症和经济负担。氨甲环酸(TXA)是一种抗纤溶药物,大量研究均已证实其能有效减少骨科手术围手术期的失血量、降低输血率和并发症发生率。同时骨科大手术患者是静脉血栓栓塞症(VTE)的高危人群,应用抗凝血药物能有效降低VTE的发生率。如何在骨科手术患者围手术期更好地应用抗纤溶药与抗凝血药,达到既可减少患者出血量、降低输血率,同时减少患者发生VTE的风险达到止血与抗凝的平衡,保障医疗安全。通过查阅文献,中国研究型医院学会关节外科学专业委员会和中国康复技术转化及发展促进会组织专家遵循循证医学原则,经过反复讨论和通讯修改,对骨科手术加速康复围手术期抗纤溶药与抗凝血药应用方案达成共识,供广大骨科医师在临床工作中参照应用。
Orthopedic surgeries are associated with a large amount of blood loss and high rate of allogeneic blood transfusion,which greatly increase the perioperative complications and economic burden of patients.Tranexamic acid(TXA)is an antifibrinolytic drug.A large number of studies have confirmed that TXA can effectively reduce the perioperative blood loss,transfusion rate and complications after orthopedic surgery.Meanwhile,patients undergoing major orthopedic surgery are at high risk of venous thrombus embolism(VTE).The use of anticoagulant drugs can effectively reduce the incidence of VTE.The ideal goal of using both TXA and anticoagulants in patients undergoing orthopedic surgery during the perioperative period is to reduce the amount of bleeding,transfusion rate and the risk of VTE in patients in order to achieve hemostasis and anticoagulation balance for medical safety.By reviewing the literatures,the Joint Surgery Specialized Committee of Chinese Research Hospital Association and the China Association of Rehabilitation Technology Transformation and Promotion organized experts to make the guideline following the principles of evidence-based medicine.After repeated discussions and communications as well as revisions,we reached the consensus on the perioperative using program of TXA and anticoagulants in patients undergoing orthopedic surgery so as to guide the daily clinical practice for a wide range of orthopedic surgeons.
作者
中国康复技术转化及发展促进会
中国研究型医院学会关节外科学专业委员会
中国医疗保健国际交流促进会关节疾病防治分会
国家卫生计生委公益科研专项《关节置换术安全性与效果评价》项目组
周宗科
黄泽宇
杨惠林
翁习生
李庭
王光林
张志强
刘涛
陈允震
沈慧勇
吴新宝
孙天胜
唐佩福
邱贵兴
裴福兴
China Association of Rehabilitation Technology Transformation and Promotion;Joint Surgery Committee of Chinese Research Hospital Association;Joint Diseases Prevention and Treatment Branch of China International Exchange and Promotion Association for Medical and Healthcare;Project Group for the"National Health and Family Planning Commissionss public-benefit project:the safety and effect assessment of joint arthroplasty";ZHOU Zongke;HUANG Zeyu;YANG Huilin;WENG Xisheng;LI Ting;WANG Guanglin;ZHANG Zhiqiang;LIU Tao;CHEN Yunzheng;SHEN Huiyong;WU Xinbao;SUN Tiansheng;TANG Peifu;QIU Guixing;PEI Fuxing(Department of Orthopedics, the seventh Medical Center of PLA General Hospital, Beijing 100700;Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China;Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041;Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu;Department of Orthopedics, Peking Union Medical College Hospital, GAMS&PUMC, Beijing 100730;Department of Orthopedics, Beijing Ji Shui Tan Hospital, Beijing 100035;Department of Orthopedics, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001;Department of Orthopedics, Qingdao Branch, Qilu Hospital of Shandong University, Qingdao 266000;Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012;Department of Orthopedics, the Eighth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510120)
出处
《中华骨与关节外科杂志》
2019年第2期81-88,共8页
Chinese Journal of Bone and Joint Surgery
关键词
骨科手术
氨甲环酸
抗凝血药
加速康复
Orthopedic Surgery
Tranexamic Acid
Anticoagulant
Enhanced Recovery After Surgery
