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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Options to reduce the need of stored blood in Total Joint Arthroplasty (TJA)
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Options to reduce the need of stored blood in Total Joint Arthroplasty (TJA)

机译：减少全关节置换术（TJA）中存储血液需求的选项

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Aims and Objectives: Stored blood units are limited and will become even scarcer in the future, as the high-birthrate age group is getting older and the number of blood donors is decreasing. Stored blood also involves risks: transmission of diseases, immunological shock, side effects. Which are the options to reduce the perioperative need of stored blood? Materials and Methods: Based on published studies, the pre-, peri- and postoperative actions and their practical application in order to prevent anemia, bleeding and the need of stored blood were compiled and evaluated. Own experiences are presented. In-house statistics were evaluated and show obvious effects. Results: The following actions should be taken into account: -Preoperative anemia has to be avoided as the risk of complications and mortality is increased. It is to be detected by blood samples and the reason for it needs to be treated. Iron deficiency is quite often the cause. The oral substitution of iron needs several weeks/months. It can also be given intravenous 2-3 weeks preoperatively. -The preoperative setting and discontinuation of anticoagulants and platelet aggregation inhibitors should be reflected. -The operation should be performed at normal temperature of the patient to allow normal function of enzyme systems and platelets. -Careful haemostasis is self-evident. -A tourniquet prevents bleeding during surgery of the knee, but reactive hyperemia may be unfavorable. -The use of a cell saver is worthwhile in blood-rich surgeries. With a drainage blood can also be collected postoperatively. -Tranexamic acid prevents fibrinolysis thus reducing bleeding. It is given preoperatively, if necessary again after 2-4 hours. Although the application is off-label in TJA, it has become established, particularly as there is good experience in other surgeries since many years. -Intra- and postoperative coagulation management is of importance. -Rational use of blood units should be standard (see guidelines). -The frequency and amount of blood samples should be restricted (1 mg of iron is lost per 2 ml of blood). In-house statistics show a clear reduction in the consumption of stored blood units after the introduction of the cell saver and the tranexamic acid. In Total hip arthroplasty the need decreased from 10 to 2.6% and in Total knee arthroplasty from 5 to 1.4%. Conclusion: With the help of an interdisciplinary collaboration of all professional groups, which should already start with the family doctor and before admission to the hospital, the demand for stored blood can be decreased and the perioperative risk for the patient will be reduced.
机译：目的和目标：随着高出生年龄组年龄的增长和献血者数量的减少，储存的血液单位是有限的，将来会变得更加稀缺。储存的血液还涉及风险：疾病传播，免疫休克，副作用。哪些方法可以减少围手术期对血液的需求？材料和方法：基于已发表的研究，对预防，预防和治疗贫血，出血和需要储存血液的术前，围术期和术后操作及其实际应用进行了评估。介绍自己的经验。对内部统计数据进行了评估，并显示出明显的效果。结果：应考虑以下措施：-术前贫血必须避免，因为并发症和死亡率的风险增加。将通过血液样本检测到它，并且需要对其进行处理的原因。铁缺乏症经常是原因。铁的口服替代需要数周/数月。也可以在术前2-3周静脉注射。 -应反映术前设置和停用抗凝药和血小板凝集抑制剂。 -手术应在患者正常温度下进行，以使酶系统和血小板正常运作。 -小心止血是不言而喻的。 -止血带可防止膝盖手术中的出血，但反应性充血可能不利。 -在血液丰富的手术中，值得使用细胞保护剂。借助引流，也可以在术后收集血液。 -氨甲环酸可防止纤维蛋白溶解，从而减少出血。术前给予，必要时2-4小时后再次给予。尽管该应用程序在TJA中是不合标准的，但它已成为公认的应用程序，特别是因为多年以来在其他外科手术中已有很好的经验。 -术中和术后凝血管理很重要。 -合理使用血液单位应该是标准的（请参阅指南）。 -应限制血液样本的频率和数量（每2毫升血液损失1毫克铁）。内部统计数据表明，引入细胞保护剂和氨甲环酸后，血液单位的消耗量明显减少。全髋关节置换术的需求从10％降低到2.6％，全膝关节置换术的需求从5％降低到1.4％。结论：在所有专业小组的跨学科合作的帮助下，这种合作应该从家庭医生开始，并且在入院之前，可以减少对血液的需求，并降低患者的围手术期风险。

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