重组人红细胞生成素联合铁剂治疗在髋膝关节置换术贫血患者中的应用研究

The rHuEPO and Iron Therapy in Preopative Anaemic Patients Following Primary Total Hip or Knee Replacement

目的观察重组人红细胞生成素联合铁剂治疗在初次髋、膝关节置换术贫血患者中的有效性及安全性。方法回顾性纳入2013年6月至2015年6月于我科行初次髋、膝关节置换术的贫血患者,根据术前是否使用重组人红细胞生成素及铁剂分为治疗组与对照组。术中所有患者均静脉联合局部使用氨甲环酸减少失血。主要观察指标为血红蛋白(hemoglobin,Hb)水平及输血率,次要指标为术前等待时间、住院时间及并发症发生率(包括感染、深静脉血栓形成、过敏、发热)。结果共纳入147例患者(髋关节置换术89例、膝关节置换术58例),治疗组84例,对照组63例。治疗组入院时Hb(105.38±7.57)g/L,术前Hb为(115.20±10.62)g/L;对照组入院时Hb(110.75±8.95)g/L,术前Hb为(112.30±12.62)g/L。治疗组术前Hb平均提高10 g/L,对照组无明显改变,差异有统计学意义(P<0.001)。治疗组术后第1、3、5天的Hb水平均高于对照组,差异有统计学意义(P<0.001)。治疗组术后第3天Hb平均降低18 g/L,对照组为22 g/L,差异有统计学意义(P=0.007)。所有患者中,仅有1例患者接受输血,无切口部位感染、深静脉血栓、过敏反应发生。结论重组人红细胞生成素联合铁剂治疗可安全有效的提高初次髋膝关节置换术前贫血患者血红蛋白水平,促进术后快速康复。

Objective To evaluate the efficacy and safety profile of rHuEPO and iron therapy in preoperative anemia patients following primary total hip（ THA） and knee arthroplasty（ TKA）. Methods Preoperative anemia patients undergone THA and TKA because of end staged hip or knee disease from June 2013 to 2015 were retrospectively involved. And they were divided into treatment group and control group based on whether r Hu EPO and iron therapy was adopted. Tranexamic acid was routinely used. The primary outcomes were Hb level and transfusion rate,secondary outcomes were length of hospital stay and complications（ such as infection,deep vein thrombosis,allergy and fever）. Results A total of 147 preoperative anemia patients（ 89 THAs and 58 TKAs） were involved. 84 patients were in treatment group,and 63 were in control group. The Hb level before surgery was（ 115. 20 ± 10. 62） g / L in treatment group,which was similar in control group（ 112. 30 ± 12. 62 g / L,P = 0.133）. The Hb level increased preoperatively by 10 g / L in treatment group（ P〈0. 001）. And the Hb level on postoperative day1 to 5 in treatment group were higher than control group with significant differences（ P〈0. 001）. The mean level of Hb drop on POD 3 was 18 g / L in treatment group,which was lower than control group（ P = 0. 007）. All of the patients,only 1 patient received transfusion,and no episode of infection,DVT or allergy reaction occurred. Conclusion The application of r Hu EPO combined with iron therapy can increase the Hb level effectively and safely in anemic patients undergoing THA and TKA.