基于ERAS理念的膝关节置换围术期 麻醉管理策略研究进展

Research Progress in Perioperative Anesthesia Management Strategies for Knee Arthroplasty Based on ERAS Concept

摘要: 加速康复外科(ERAS)是指采用有循证医学证据的围术期处理的一系列优化措施，其核心是减少在围术期各个阶段对患者的创伤和应激，优化手术安全性和患者满意度，实现快速康复的目标。围手术期麻醉管理是ERAS重要的组成部分，对围手术期患者的术后疼痛管理、早期康复、预防术后并发症都有重要作用。本文从ERAS理念角度总结膝关节置换围术期麻醉管理研究的进展，包括术前评估及优化、麻醉方式选择、麻醉镇痛特别是神经阻滞和多模式镇痛、围术期血液管理、围手术期快速康复等方面总结了研究进展，阐明目前全身麻醉和区域麻醉长期预后差异。期望能够给围术期麻醉管理建立标准化、高质量膝关节置换麻醉方案提供循证基础及实践指导。

Abstract: Enhanced Recovery after Surgery (ERAS) refers to a series of evidence-based optimized perioperative interventions. Its core lies in minimizing perioperative trauma and stress at all stages, improving surgical safety and patient satisfaction, and ultimately achieving the goal of rapid postoperative recovery. Perioperative anesthetic management constitutes a critical component of Enhanced Recovery after Surgery (ERAS), and exerts a pivotal role in postoperative pain control, early rehabilitation, and the prevention of postoperative complications. From the perspective of the ERAS paradigm, this review summarizes the recent advances in perioperative anesthetic strategies for knee arthroplasty, covering preoperative evaluation and optimization, anesthetic technique selection, analgesic management with emphasis on nerve blocks and multimodal analgesia, perioperative blood management, and perioperative enhanced recovery protocols. Differences in long-term outcomes between general anesthesia and regional anesthesia are also elucidated. This review aims to provide an evidence-based foundation and practical guidance for establishing standardized, high-quality anesthetic regimens in perioperative care for knee arthroplasty.