血友病患者关节手术的围手术期处理

目的探讨血友病患者行关节手术治疗时的围手术期处理方法。方法2002年12月到2009年6月,在血液内科的配合下,6例男性血友病患者成功施行了关节手术(4例膝关节关节镜手术,1例全髋关节置换术,1例髋关节离断术)。在围手术期间监测凝血功能以及凝血因子的活性水平,术前、术中及术后均予以补充凝血因子,并按需补充冷沉淀以及新鲜冰冻血浆。术前及术后2周患者的关节功能改善程度采用KSS或HSS评分。结果4例膝关节手术患者术后2周KSS临床评分(77.75±10.29)分,功能评分(68.75±9.37)分;1例全髋关节置换患者术后两周HSS评分为66分。结论对骨科血友病患者行关节手术治疗,若在围手术期将血中凝血因子的促凝活性维持在止血水平,同时给以足够的对症支持治疗,那么手术是可行且安全的。

Perioperative management of joint surgery for hemophilic patients

Objective To discuss the perioperative management of joint surgery for hemophilic patients. Methods In cooperation with the hematology, 6 male patients with hemophilia （Knee arthroscopy surgery was done in 4 cases, total hip replacement was done in 1 case and hip disarticulation was done in 1 case） underwent joint surgery from Dec.2002 to Jun.2009. During perioperative period, the function of coagulation, the level of activity of clotting factors and infused coagulation factors were monitored. Cryoprecipitate and fresh frozen plasma were infused according to actual situation. The function of joint was evaluated by KSS or HSS. Results The KSS score was （77.75±10.29） and functioning score was （68.75±9.37） in 4 patients with knee surgery. The HSS score was 66 in 1 patient with hip replacement. Conclusions As long as the clotting factors are monitored in hemostatic level during the perioperative period, it is feasible for hemophilic patients with joint surgery.