重组人促红细胞生成素联合铁剂纠正老年股骨转子间骨折患者围术期贫血的临床研究

Clinical study of recombinant human erythropoietin combined with iron to correct perioperative anemia in elderly patients with intertrochanteric fractures

目的探讨重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)联合铁剂纠正老年股骨转子间骨折患者围术期贫血的疗效。方法回顾分析2016年4月-2017年10月符合选择标准的71例老年股骨转子间骨折患者临床资料,均行闭合复位股骨近端髓内钉固定治疗。其中31例术前应用rHuEPO联合铁剂纠正贫血(试验组),40例未使用rHuEPO及铁剂(对照组)。两组患者性别、年龄、体质量指数、致伤原因、骨折侧别及分型、美国麻醉医师协会(ASA)分级、合并内科疾病、骨折至入院时间、术前住院时间以及手术时间比较,差异均无统计学意义(P>0.05)。记录两组患者入院时及术后1、3、7 d血红蛋白水平,术后输血患者例数并计算输血率,术后输血量,术后并发症发生情况以及术后住院时间。结果术后试验组8例(25.8%)、对照组22例(55.0%)输血,试验组输血量为(1.96±0.85)U,明显低于对照组的(3.19±1.61)U;两组输血率及输血量比较差异均有统计学意义(P<0.05)。两组术前血红蛋白水平比较,差异无统计学意义(P>0.05);术后试验组均高于对照组,其中术后7 d差异有统计学意义(P<0.05)。试验组术后住院时间为(6.16±3.97)d,较对照组的(9.25±4.47)d明显缩短(P<0.05)。术后试验组8例(25.8%)、对照组14例(35.0%)发生肺部感染,试验组6例(19.4%)、对照组8例(20.0%)发生下肢深静脉血栓形成,并发症发生率差异均无统计学意义(P>0.05)。所有患者均正常出院,住院期间无死亡。结论老年股骨转子间骨折患者术前应用rHuEPO联合铁剂能快速提高术后血红蛋白水平,缩短住院时间,而且不增加术后下肢深静脉血栓形成发生风险。

Objective To investigate the effectiveness of recombinant human erythropoietin(rHuEPO combined with iron in treatment of anemia in elderly patients with intertrochanteric fractures during perioperative period. Methods A clinical data of 71 patients with intertrochanteric fractures met the inclusion criteria between April2016 and October 2017 was retrospectively analyzed. All patients were treated with closed reduction and proximal femoral intramedullary nail fixation. Thirty-one patients were treated with rHuEPO and iron before operation as trial group, and40 patients were not treated with rHuEPO and iron as control group. There was no significant difference in gender, age,body mass index, cause of injury, fracture side and classification, American Society of Anesthesiologists(ASA)classification, combined medical diseases, time from fracture to admission, preoperative hospital stay, and operation time between the two groups(P>0.05).The hemoglobin levels before operation and at 1, 3, and 7 days after operation, number of blood transfusion, blood transfusion rate, blood transfusion volume, postoperative hospital stay, complications were recorded and compared. Results After operation, 8 patients(25.8%) in trial group and 22 patients(55.0%) in control group received blood transfusion;the blood transfusion volume was(1.96±0.85) units in trial group and(3.19±1.61) units in control group. There were significant differences in blood transfusion rate and volume between the two groups(P<0.05). There was no significant difference in preoperative hemoglobin level between the two groups(P>0.05). The postoperative hemoglobin level was higher in trial group than in control group, and the difference between the two groups was significant at 7 days(P<0.05). The postoperative hospital stay was(6.16±3.97) days in trial group and(9.25±4.47) days in control group, showing significant difference between the two groups(P<0.05). There were 8 patients(25.8%) with pulmonary infection in trial group and 14(35.0%) in control group after operation;6 patients(19.4%) with deep venous thrombosis in trial group and 8(20.0%) in control group. There was no significant difference in the incidences of complications between the two groups(P>0.05). All patients were discharged from hospital normally, and no one died during hospitalization. Conclusion The application of rHuEPO combined with iron before operation in elderly patients with intertrochanteric fractures can rapidly increase the hemoglobin level after operation, shorten the hospital stay, and do not increase the risk of deep venous thrombosis after operation.