《中华骨与关节外科杂志》2016年2月第9卷第1期Chinese Journal of Bone and Joint Surgery Vol.9,No.1,Feb2016△共同第一作者*通信作者：牛挺，E-mail ：tingniu@ ；王坤正，E-mail ：wkzh1955@ ；王兆钺，E-mail ：zwang11@ ；邱贵兴，E-mail ：xshweng@ ；裴福兴，E-mail ：peifuxing@∙专家共识∙文章编号：2095-9958（2016）02--09DOI ：10.3969/j.issn.2095-9958.2016.01-01中国髋、膝关节置换术加速康复——围术期贫血诊治专家共识国家卫生和计划生育委员会（以下简称“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》项目组中华医学会骨科学分会关节外科学组中国医疗保健国际交流促进会骨科分会关节外科委员会周宗科1△翁习生2△向兵3△曲铁兵4△张先龙5△唐佩福6△吴海山7△朱振安8△廖威明9△钱齐荣7△邵宗鸿10△钱申贤11△蒋青12△牛挺3*王坤正13*王兆钺14*邱贵兴2*裴福兴1*（1.四川大学华西医院骨科，成都610041；2.中国医学科学院北京协和医学院北京协和医院骨科，北京100730；3.四川大学华西医院血液科，成都610041；4.北京朝阳医院骨科，北京100020；5.上海市第六人民医院骨科，上海200233；6.中国人民解放军总医院骨科，北京100039；7.上海长征医院骨科，上海200003；8.上海交通大学医学院附属第九人民医院骨科，上海200011；9.中山大学附属第一医院骨科，广州510080；10.天津医科大学总医院血液科，天津300052；11.杭州市第一人民医院血液科，杭州310006；12.南京鼓楼医院骨科，南京210008；13.西安交通大学医学院第二附属医院骨科；西安710004；14.苏州大学附属第一医院血液科，苏州215006）【摘要摘要】】髋、膝关节置换术（total hip/knee athroplasty,THA/TKA ）患者中相当一部分存在术前贫血，加之手术创伤大、出血多，容易导致术后贫血或贫血加重，故术后异体输血率高。

如果贫血得不到纠正会严重影响患者的预后，如增加感染风险、延缓术后康复、延长住院时间、增加致残率及死亡风险。

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，编辑整理完成本共识，供广大骨科医师在临床工作中参考应用。

本共识主要内容包括：关节置换术围术期贫血发生的原因、诊断及分型和治疗，关节置换术围术期贫血的治疗主要包括治疗起始值、原发疾病的治疗、均衡膳食、促红细胞生成素及铁剂的补充原则及方法。

【关键词关键词】】加速康复；全髋关节置换术；全膝关节置换术；围手术期医护；贫血Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:diagnosis and treatment of perioperative anemiaProject group for the National Health and Family Planning Commission's public-benefit project:the safety andeffect assessment of joint arthroplastyJoint Surgery Society of Chinese Orthopaedic AssociationJoint Surgery Committee of Orthopedics Branch of China International Exchange and Promotive Association forMedical and Health CareZHOU Zongke 1△,WENG Xisheng 2△,XIANG Bing 3△,QU Tiebing 4△,ZHANG Xianlong 5△,TANG Peifu 6△,WU Haishan 7△,ZHU Zhen'an 8△,LIAO Weiming 9△,QIAN Qirong 7△,SHAO Zonghong 10△,QIAN Shenxian 11△,JIANG Qing 12△,NIU Ting 3*,WANG Kunzheng 13*,WANG Zhaoyue14*,QIU Guixing 2*,PEI Fuxing 1*(1.Orthopedics Department,West China Hospital,Sichuan University,Chengdu 610041;2.Orthopedics Department,Peking Union Medical College Hospital,CAMS &PUMC,Beijing 100730;3.Department of Hematology,West China Hospital,Si-chuan University,Chengdu 610041;4.Orthopedics Department,Beijing Chaoyang Hospital,Beijing 100020;5.Orthopedics Department,Shanghai Sixth People's Hospital,Shanghai 200233;6.Orthopedics Department,Chinese PLA General Hospi-tal,Beijing 100039;7.Shanghai Changzheng Hospital,Shanghai 200003;8.Orthopedics Department,Shanghai Ninth Peo-ple's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011;9.Orthopedics Department,First Affil-iated Hospital,Sun Yat-Sen University,Guangzhou 510080;10.Department of Hematology,General Hospital of Tianjin Medical University,Tianjin 300052;11.Department of Hematology,Hangzhou First People's Hospital,Hangzhou 310006;12.Orthopedics Department,Nanjing Drum Tower Hospital,Nanjing 210008;13.Orthopedics Department,Second Affiliat-ed Hospital,X'an Jiao Tong University School of Medicine,Xi'an 710004;14.Department of Hematology,First AffiliatedHospital,Soochow University,Suzhou 215006)0010Chinese Journal of Bone and Joint Surgery Vol.9,No.1,Feb2016transfusion.The anemia will increase the infection,delay the recovery,prolong the length of hospital stay and increase the disability and mortality.By means of reading literatures and expert group discussion,based on 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 consensus which mainly involves pathogenesis,diagno-sis,treatment and types of anemia during perioperative period of THA/TKA.The treatment of anemia contains the treatment of underlying diseases,balanced diet and the use of erythropoietin and intravenous iron.We hope that this consensus would give some help to orthopedists.【Key words】Enhanced Recovery After Surgery(ERAS);Total Hip Arthroplasty(THA);Total Knee Arthroplasty(TKA);Perioperative Care;Anemia目前，髋、膝关节置换术（total hip/knee athroplas-ty,THA/TKA）已在国内普遍开展，由于THA和TKA 患者中相当一部分存在术前贫血，加之手术创伤大、出血多，容易导致术后贫血或贫血加重，故术后异体输血率高[1-3]。

如果贫血得不到纠正会严重影响患者的预后，如增加感染风险、延缓术后康复、延长住院时间、增加致残率及死亡风险[4,5]。

因此，THA和TKA 患者围术期贫血的诊断与治疗尤为重要。

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（以下简称“项目组”，项目号：201302007）和《中华骨与关节外科杂志》联合中华医学会骨科学分会关节外科学组、中国医疗保健国际交流促进会骨科分会关节外科委员会共同邀请国内共66位专家，复习国内外3篇meta分析、100多篇论著，结合26家项目组医院和50家推广医院数据库共20308例THA、TKA和股骨头置换术病例数据，遵循循证医学原则，编辑整理完成本共识，供广大骨科医师在临床工作中参考和应用。