重组人促红细胞生成素对降低老年股骨粗隆间骨折围手术期输血的病例对照研究

Case-control study on the efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures

目的 :评价术前应用重组人促红细胞生成素(recombinant human erythropoietin,r Hu EPO)对降低老年股骨粗隆间骨折择期手术患者围手术期输血的作用。方法:回顾性分析自2011年1月至2013年12月收治的老年股骨粗隆间骨折患者442例,根据纳入及排除标准,最终入选119例。其中治疗组52例,男12例,女40例,平均年龄(71.4±12.8)岁,术前接受r Hu EPO 10 000 U(隔日1次)加右旋糖酐铁200 mg(每日3次);对照组67例,男16例,女51例,平均年龄(70.9±16.2)岁,术前仅接受右旋糖酐铁200 mg(每日3次)。所有患者采用PFNA-Ⅱ(辛迪思公司)或Intertan(施乐辉公司)在闭合复位下固定骨折,观察两组患者围手术期输血率、平均输血量、术后并发症、住院时间及30 d内死亡率。结果:119例中71例围手术期接受了至少1 U(200 ml)异体血输入。治疗组围手术期输血率48.1%,低于对照组的68.7%(χ2=4.77,P<0.05);治疗组平均输血量(1.8±0.4)U/pte,低于对照组的(3.6±1.1)U/pte(t=2.244,P<0.05)。治疗组术后1周及30 d血红蛋白水平高于对照组,且治疗组术后30 d较入院时血红蛋白水平高。两组术后血栓事件、术后感染发生率及住院时间比较差异无统计学意义。结论:对于择期手术的老年股骨粗隆间骨折患者,术前应用r Hu EPO可降低围手术期输血率及平均输血量,但其长期安全性仍有待评价。

Objective：To evaluate preoperative application of recombinant human erythropoietin （rHuEPO） in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanterie fractures. Methods： From January 2011 to December 2013,442 cases of elderly patients with femoral intertroehanterie fracture were retrospectively re- viewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females ,with a mean age （71.4±12.8） years old ,and the patients received preoperative administration of rHuEPO 10 000 U qod combined with iron dextran 200 mg （3 times each day）. While 16 males and 51 females in control group, with a mean age （70.9±16.2） years old, and the patients only received preoperative adminis- tration of iron dextran 200 mg （3 times each day）. All the patients received closed reduction and PFNA- II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups. Results ：There were no statistical differ- ences between two groups in the baseline indexes （P〉0.05）. Overall,71 of 119 patients （59.7%） received at least one unit al- logeneic blood transfusion （ABT）. However,there were significant differences in perioperative ABT rates（48.1% vs 68.7% ,x^2= 4.77 ,P〈0.05 ） and the average amount of blood transfusion between treatment group and control group ,which were （1.8±0.4） U/pte vs （3.6±1.1） U/pte （t=2.244 ,P〈0.05 ）. Postoperative hemoglobin （Hb） on postoperative clays 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were （128.2±20.6） g/L vs （118.2±18.9） g/L （t=2.133 ,P〈0.05 ）. There were no statistical differ- ences in postoperative complications, the length of hospital stay and mortality within 30 days. Conclusion：For elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly re- duce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.