静脉铁剂与促红细胞生成素治疗髋关节置换术前贫血患者的效果观察

Effect observation of intravenous iron and erythropoietin in anemia patients before hip replacement surgery

目的：观察静脉铁剂与促红细胞生成素治疗髋关节置换术前贫血患者的临床效果。方法：选择行髋关节置换术伴缺铁性贫血（ASAⅠ-Ⅲ级）患者100例,男性Hb〈120 g/L,女性〈110 g/L;其中,男性58例,女性42例。将患者分为研究组和对照组,每组各50例。研究组患者术前2周至术后1周皮下注射促红细胞生成素100 IU/kg,每周3次;并静脉输注蔗糖铁200 mg,每周2次。对照组患者未注射静脉铁剂与促红细胞生成素。术前和术后,检测两组患者的血红蛋白（Hb）和红细胞压积（Hct）,并比较两组患者贫血治疗的效果,异体输血及恢复情况。结果：术前、术后1 d、术后1周和2周,研究组患者的Hb和Hct均高于对照组,两组患者的术中失血量无明显差异;研究组患者的异体输血率、输血量、发热、肺部感染等并发症均低于对照组（P〈0.05）。结论：髋关节置换术前贫血患者予以静脉铁剂与促红素治疗有利于提高其围术期血红蛋白,减少异体输血,降低发热及肺部感染发生率。

Objective To evaluate clinical effects of intravenous iron and erythropoietin （EPO） in anemia patients before hipreplacement surgery. Methods： 100 cases （male 58 cases, female 42 cases） scheduled for elective hip replacement surgery and com-bined with iron-deficiency anemia （ASA Ⅰ-Ⅲ, male Hb 〈120g and female Hb 〈110g） were selected and divided into study group （n = 50） and control group （n = 50）. The study group was subcutaneously injected with EPO 100U/Kg from 2 weeks before the surgery and 1 week after the surgery at 3 times a week, and intravenously injected with iron sucrose 200 mg at times a week, while the control group did not receive any treatments. The hemoglobin （ Hb） and hematocrit （Hct） levels of the two groups before and after the surgery were determined. The treatment effects of anemia as well as allogenetic blood transfusion and recovery conditions of the two groups were compared. Results ： Before and 1d, and 2 weeks after the surgery, the Hb and Hct levels of study group were higher than those of con-trol group; however, there was no significant difference in the intraoperative blood loss between the two groups. The allogeneic blood transfusion rate and amount, fever, lung infection and other complications of stud group were lower than those of control group （ P 〈 0.05）. Conclusions： For the anemia patients before hip replacement surgery, intravenous iron and erythropoietin can improve the perioperative hemoglobin level, reduce allogeneic blood transfusions, and reduce the incidences of fever and lung infection.