重组人促红细胞生成素在人工全膝关节置换术围术期的应用研究

Application of recombinant human erythropoietin in the perioperative period of total knee arthroplasty

背景:膝关节置换手术常会导致患者需要输血治疗,而目前的血液资源紧张以及输注同种异体血可能会带来风险,这让如何减少关节置换术患者异体输血的需要成为大家共同关心的问题。目的:观察重组人促红细胞生成素(erythropoietin,EPO)在人工全膝关节置换术中的应用效果。方法:回顾性分析2015年1月至12月收住我院行膝关节置换的146例患者,其中,男34例,女112例,右膝手术82例,左膝手术64例。按是否应用EPO分为EPO组和对照组,EPO组共82例,女70例;对照组共64例,女52例。EPO组患者接受EPO联合静脉蔗糖铁治疗,使用方法为蔗糖铁200 mg静脉滴注,每日1次;EPO使用方法为每日1万IU,皮下注射,每日1次,使用日期从术前1 d开始,总量不超过10 d。术前和术后检测两组血红蛋白(hemoglobin,Hb)和红细胞压积(hematocrit,HCT),并比较两组贫血治疗效果、异体输血及并发症情况。结果:两组术前一般情况比较差异无统计学意义(P>0.05)。EPO组平均用药时间为(7.41±2.50)d。EPO组平均异体输血量低于对照组(P<0.05)。EPO组手术前后Hb降低值及HCT降低值低于对照组(P<0.05)。两组术前Hb及HCT、术后最低Hb及HCT、术后引流量比较差异无统计学意义(P>0.05)。结论:围术期短期应用EPO联合蔗糖铁进行红细胞动员有效果,可以进一步帮助患者快速康复。

Background： Total knee arthroplasty surgery often need blood transfusion. Currently how to reduce the need for blood transfusion in total knee arthroplasty with the deficiency of blood resources and risk of allogeneic blood transfusion has become our common concern. Objective： To evaluate clinical effects of recombinant human erythropoietin（EPO） in the perioperative period of total knee arthroplasty. Methods：A retrospective study was performed in 146 patients（34 males, 112 females）who underwent unilateral total knee arthroplasty from January 2015 to December 2015. All patients were divided into two groups： EPO group（n=82）including patients treated with erythropoietin and iron saccharate and control group（n=64）including patients without erythropoietin and iron saccharate treatment. EPO group was subcutaneously injected with EPO 10000 IU once daily from the day before the surgery and the total period was no more than 10 days, and intravenously injected with iron saccharate 200 mg once daily, while the control group did not receive any treatments. The indexes of hemoglobin（Hb） and erythrocyte hematocrit（HCT） were tested and therapeutic effect of anemia, allogeneic blood transfusion and complications were analyzed and compared between two groups. Results： The difference of baseline data between two groups was not statistically significant（P〉0.05）. The mean treatment duration of EPO and iron saccharate was（7.41±2.50）days in EPO group. Compared with control group the allogeneic blood transfusion volume of EPO group was lower（P〈0.05）. The difference of Hb change and HCT change before and after surgery between the two groups were statistically significant（P〈0.05）. There were no statistically significant difference in Hb and HCT level before surgery, the lowest Hb and HCT after surgery and blood drainage volume after surgery between two groups（P〉0.05）. Conclusions： The short term application of EPO combined with iron saccharate therapy in the perioperative period can decrease the Hb lost effectively and safely in patients undergoing total knee arthroplasty and help them recovered rapidly.