铁剂和促红细胞生成素联合应用对妇科贫血患者围术期异体血需求的影响

Effect of combined serum ferritin and erythropoietin on heterogeneous blood transfusion in perioperative gynecological anemia patients

目的探讨静脉联合应用铁剂和促红细胞生成素对妇科贫血患者围术期异体血需求的影响。方法选取2012年8—11月于本院行妇科择期手术的子宫肌瘤贫血患者[术前血红蛋白（Hb）70～100~L160例，随机分为实验组和对照组各30例。对照组不用药，实验组术前以及手术当日皮下注射人促红细胞生成素各5000iU，同时静脉注射蔗糖铁。根据围术期患者Hb水平确定是否输注少量白、红细胞悬液，严密观察用药反应，记录患者术前4d、手术当天、术后第1、3、5天（记为-4，0，＋1，＋3，＋5）的实验室检查f包括血红蛋白、血细胞比容（Hct）、网织红细胞百分比（RET％）、红细胞计数（RBC）、血清铁蛋白（SV）]、红细胞输入量及相关并发症，术后1个月电话随访并记录复查的血红蛋白值。结果围术期实验组Hb、Hct、RET％在0、＋1、＋3、＋5d与对照组相比显著增高俨〈0．01），实验组术后的铁蛋白与对照组相比显著增高（P〈0．01）。实验组仅有2例接受异体输血，且每人1U，平均为0．07u／例；对照组10例输血，共20U，平均为0．67U／例，实验组异体输血率显著降低俨〈0．01）。结论围术期妇科贫血患者静脉联合应用蔗糖铁和促红细胞生成素可有效减少贫血并能减少异体血输入。

Objective To study the effect of combined serum ferritin （SF） and erythropoietin on heterogeneous blood transfusion in perioperative gynecological anemia patients. Methods Sixty anemia patients with hysteromyoma who underwent operation in our hospital from August 2012 to November 2012 were divided into experimental group with their Hb ≤ 70 g/L （n=30） and control group with their Hb ≤ 100 g/L （n=30）. Patients in experimental group were subcutaneneously injected with 5 000 IU human erythropoietin and intraveinous injected with SF before operation and on the day of operation. White and red blood cell suspension was transfused depending on their perioperative Hb level. Hb, Hct, RET %, RBC, SF and complications were recorded 4 days before operation, on operation day, and on day 1, 3, 5 after operation. The patients were followed up for 1 month after operation during which their hemoglobin was recorded. Results The Hb and Hct levels and RET % were significantly higher in experimental group than in control group on day 0, 1, 3, 5 after operation（P 〈 0.01）. The SF level was significantly higher in experimental group than in control group（P 〈 0.01）. The perioperative heterogeneous blood transfusion was significantly less in experimental group than in control group （1 U vs 20 U, 0.07 U/case vs 0.67 U/case,P 〈 0.01）. Conclusion Combined erythropoietin and SF can effectively improve anemia and reduce heterogeneous blood transfusion in perioperative gynecological anemia patients.