EPO对脊柱外科病人围术期异体血需求和凝血功能影响

EFFECT OF ERYTHROPOIETIN ON PERIOPERATIVE DEMAND OF ALLOGENIC TRANSFUSION AND BLOOD CLOTTING FUNCTION IN PATIENTS UNDERGOING SPINAL SURGERY

目的探讨促红细胞生成素（EPO）对脊柱外科病人围术期异体血需求和凝血功能的影响。方法将60例脊柱外科病人随机分为实验组和对照组各30例。实验组于术前7、1d皮下注射重组人促红细胞生成素（rHuEPO）各5 000U,同时于术前1d静脉注射蔗糖铁溶液100mg。对照组不用rHuEPO和蔗糖铁溶液。两组根据围术期血红蛋白水平决定术中是否输血。检测两组病人术前7、1d及术后1、3、7、30d的红细胞计数（RBC）、血红蛋白（Hb）、血细胞比容（HCT）、网织红细胞百分比（RET%）、血小板计数（PLT）,术前7、1d及术后1、3d的凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（Fib）浓度,同时记录手术时间、术中失血量、术后引流量、红细胞输入量及相关并发症。结果实验组术前1d时RBC、Hb、HCT、RET%较术前7d显著升高（F=56.50～195.02,P〈0.05）;在术前1d及术后3、7d,实验组RBC、Hb、HCT、RET%显著高于对照组（t=2.35～13.46,P〈0.05）。两组术后1、3d时PLT较术前下降,术后7d升高且高于术前水平,差异有显著性（F=27.99、36.21,P〈0.05）,相同时间点两组PLT差异无显著性（P〉0.05）。两组术后1、3d时PT、APTT与术前相比明显延长（F=45.62～88.68,P〈0.05）,相同时间点两组PT、APTT、Fib差异无显著性（P〉0.05）。两组术中失血量、术后引流量比较差异无显著性（P〉0.05）,实验组异体输血量明显少于对照组（t=2.10,P〈0.05）。两组围术期及随访均未发现栓塞等并发症。结论出血量较多的脊柱外科手术应用EPO可有效提高Hb水平及减少术中异体血输入,且对凝血功能无影响,不会增加术后栓塞等并发症的发生率。

Objective To study the effect of erythropoietin on perioperative allogenic blood transfusion and blood clotting function in patients undergoing spinal surgery. Methods Sixty patients undergoing spinal surgery were equally randomized to experimental group and control group.Patients in the experimental group were subcutaneously injected 5 000 Uof recombinant human erythropoietin（rHuEPO）one day and seven days before operation,and intravenously injected iron sucrose 100 mg one day before operation,those in the control group were injected neither rHuEPO nor iron sucrose.Whether or not blood was transfused was decided according to hemoglobin levels at surgery.Seven days and one day before surgery,and one,three,seven and 30 days after surgery,the following items of patients in the two groups were detected and recorded-red blood count（RBC）,hemoglobin（Hb）,hematocrit（HCT）,reticulocyte percentage（RET%）and platelet count（PLT）;seven days and one day before surgery,one day and three days after surgery,the items detected were as follows：prothrombin time（PT）,activated partial prothrombin time（APTT）and fibrinogen（Fib）.Operation time,intraoperative blood loss,postoperative drainage,blood transfusion and complications were recorded. Results RBC,Hb,HCT and RET%in the experimental group were significantly higher,one day before surgery versus seven days before surgery（F=56.50-195.02,P〈0.05）.A comparison between the two groups showed that the levels of RBC,Hb,HCT and RET%in the experimental group-one day before,three and seven days after surgery-were higher than that in the control（t=2.35-13.46,P〈0.05）.The PLT levels in the two groups-one and three days after surgery-declined,and elevated seven days after surgery to the levels higher than that before surgery,the difference was significant（F=27.99,36.21;P〈0.05）.There was no significant difference of PLT levels between the two groups at the same time point（P〈0.05）.PT and APTT-one day and three days after surgery-were significantly extended compared with that before surgery（F=45.62-88.68,P〈0.05）.No significant differences of PT,APTT and Fib were found between the two groups at the same time point（P〈0.05）.No significant differences were noted between the two groups in regard to intraoperative blood loss and postoperative drainage（P〈0.05）,but blood transfusion in experimental groupwas significantly less than that in the control（t=2.10,P〈0.05）.No complications,such as embolism,were noted in both groups.Conclusion Preoperative erythropoietin in spinal surgery,aprocedure that may cause profuse intraoperative bleeding,can effectively raise hemoglobin levels and reduce blood transfusion,and does not affect blood clotting function and increase the incidence of complications such as embolism,and so on.