重组人EPO联合蔗糖铁在孕妇妊娠晚期预存式自体输血的应用

Application of human recombinant erythropoietin combined iron saccharate among predeposit autologous blood transfusion in late-stage pregnant women

目的:探讨重组人促红细胞生长素(rh-EPO)与蔗糖铁在孕妇妊娠晚期预存式自体输血中的临床应用价值。方法:以2014-01-2015-06术中失血量>400 ml、妊娠晚期行预存式自体输血的112例孕妇为研究对象,按入院顺序分为2组,每组56例。2组患者分别于术前7d和术前3d采血400ml,每次采血后按1∶1的比例输注400ml琥珀酰明胶和复方乳酸钠混合液以补充血容量,术中或术后回输给患者。观察组于术前10d起隔日皮下注射rh-EPO 150U/kg,同时静脉补充蔗糖铁注射液100mg,1次/3d,用至术后第7天;对照组不应用rh-EPO和蔗糖铁注射液。记录2组患者第1次采血前、术前1h、术后第1天、第5天的RBC、Hb、Hct以及围术期并发症、术中失血量和输血量、术后恢复情况。结果:与第1次采血前比较,2组术前1h、术后第1天、第5天RBC、Hb及Hct明显降低(P<0.05)。与对照组比较,观察组术后第1天、第5天RBC、Hb及Hct明显升高(P<0.05);2组患者自体血回输过程中未发生寒战、发热、过敏等输血不良反应。观察组未发生血黏度增高、血栓等并发症。结论:rh-EPO与蔗糖铁联合应用于孕妇妊娠晚期预存式自体输血,可充分发挥患者自身的造血潜能,显著改善患者的贫血状况。

Objective：To explore the application value of human recombinant erythropoietin（rh-EPO） combined iron saccharate among predeposit autologous blood transfusion in late-stage pregnant women. Method： One hundred and twelve cases of late-stage pregnant women estimated intraoperative blood loss 〉 400 ml and conducted predeposit autologous blood transfusion were chosen as the research objects from January 2014 to June 2015. According to admission order, all patients were divided into observation group and control group, 56 cases in each group. 400 ml of blood were collected at 7 d and 3 d before operation in both groups, and added blood volume by equal amount of succinyl gelatin and sodium lactate after blood collection, and mixture solutions were infused back to the patients during operation or the end of the surgery. 150 U/（kg . d） of rh-EPO were injected at 10 d before operation to 7 d after operation with iron saccharate injection 100 mg at the same time （1/3 d, used till postoperative 7 d ） in observation group, rh-EPO and iron saccharate were not applied in control group. Red blood cell （RBC）, hemoglobin （Hb） and hematocrit （Hct） before first blood collection, preoperative 1 h, postoperative 1 d and 5 d were recorded. Perioperative complications, intraoperative blood loss, blood transfusion amount and postoperative recovery were observed. Result：Compared with the first blood collection, RBC, Hh and Hct at preoperative 1 h, postoperative 1 d and 5 d were decreased significantly （P〈0.05） in both groups. Compared with the control group, RBC, Hb and Hct were increased significantly at the first and fifth postoperative day （P〈0.05） in observation group. No adverse reactions such as chills, fever, allergies occurred in autologous blood transfusion. The complications such as increased blood viscosity, blood clots did not appear in observation group. Conclusion： rh-EPO and iron saccharate may be safe and effective drugs among predeposit autologous blood transfusion in latestage pregnant women, which can give full play to the patient＇s own hematopoietic potential, and improve effectively the condition of intraoperative and postoperative patients with anemia.