fmx_T3RoZXJNaXJyb3Jz
中华骨科杂志2025年4月第45卷第7期 Chin J Orthop, April 2025, Vol.45, No.7 ·393·
·共 识·
骨科、麻醉科加速康复围手术期患者
血液管理专家共识（2025年版）
中国康复技术转化及发展促进会 中华医学会麻醉学分会
中国医师协会麻醉学医师分会 中国研究型医院学会
通信作者：缪长虹，Email: miaochh@aliyun.com；吴新宝，Email: wuxinbao_jst@126.com；
俞卫锋，Email: ywf808@yeah.net；裴福兴，Email: peifuxing@vip.163.com
【摘要】 围手术期患者血液管理是骨科手术加速康复成功实施的关键技术之一，其核心理念是通过一系列措施增加
患者术前血液储备、降低出血风险、减少围手术期失血及提高贫血耐受性。虽然围手术期患者血液管理的临床获益显著，
但对多学科之间的共性问题仍有待进一步达成共识。共识基于Delphi法的实践要求，对骨科医生、麻醉科医生共同关注
的术前缺铁性贫血的诊断与治疗、术中微创操作、氨甲环酸的应用、控制性降压及术后贫血诊治等18个临床问题相关的
循证医学证据与临床实践进行了系统总结并形成共识，旨在促进以患者为中心的骨科加速康复更好地实施。
【关键词】 术后加速康复；疾病管理；循证医学；共识
【共识注册】 国际实践指南注册与透明化平台（PREPARE⁃2025CN388）
DOI: 10.3760/cma.j.cn121113⁃20250123⁃00070
Expert consensus on perioperative blood management in orthopaedics and anesthesiology for enhanced recovery after
surgery (2025 version)
China Association of Rehabilitation Technology Transformation and Promotion; Chinese Medical Association of Anesthesiology; Chi⁃
nese Medical Doctor Association of Anesthesiologist; Chinese Research Hospital Association
Corresponding author: Miao Changhong, Email: miaochh@aliyun.com; Wu Xinbao, Email: wuxinbao_jst@126.com; Yu Weifeng,
Email: ywf808@yeah.net; Pei Fuxing, Email: peifuxing@vip.163.com
【Abstract】 Perioperative blood management for patients is one of the key techniques for the successful implementation of
enhanced recovery after orthopaedic surgery. Its core concept is to increase the preoperative blood reserve of patients, reduce the
risk of bleeding, minimize perioperative blood loss, and improve anemia tolerance through a series of measures. Although the clini⁃
cal benefits of perioperative patient blood management are significant, there is still a need to further reach consensus on the com⁃
mon issues among multiple disciplines. Based on the practice requirements of the Delphi method, the consensus systematically
summarizes the evidence⁃based medical evidence and clinical practice related to 18 clinical questions, including the diagnosis
and treatment of preoperative iron deficiency anemia, minimally invasive operation during surgery, the application of tranexamic
acid, controlled hypotension, and the diagnosis and treatment of postoperative anemia, which are of common concern to orthopae⁃
dic surgeons and anesthesiologists. The consensus aims to promote the better implementation of patient⁃centered enhanced recov⁃
ery after orthopaedic surgery.
【Key words】 Enhanced recovery after surgery; Disease management; Evidence⁃based medicine; Consensus
【Consensus registration】 Practice Guideline Registration for Transparency (PREPARE⁃2025CN388)
DOI: 10.3760/cma.j.cn121113⁃20250123⁃00070
一、制订背景
骨科手术患者围手术期贫血发生率较高，择期
手术患者术前贫血发生率约为23%~26%［1］，创伤骨
科患者高达 42%~45%［2］。骨科手术大量失血与异
体输血会增加手术并发症，延缓术后康复，降低患
者生活质量［3-5］。
围手术期患者血液管理是骨科加速康复的关键
技术之一［6］，其核心目标是以循证医学为基础，以患
者为中心，通过术前促进红细胞生成、改善术前贫
血、减少术中失血及增强术后对贫血的耐受，进而实
现优化输血策略、降低输血需求和改善患者预后。
近年来，虽然在骨科、麻醉科、血液科医生和临
床药师的共同努力下，加速康复外科围手术期血液
管理理念不断深入，围手术期患者血液管理的各项
措施已逐渐取得进步，但与世界卫生组织在2010年
提出的患者血液管理目标仍存在一定差距，特别是
术前贫血诊治、术中血液管理及术后贫血的防治有
待进一步规范。
