54例无法输血的危重贫血患者应用血红蛋白氧载体后生存率的影响因素分析  

作　　者：Colin F. Mackenzie MB ChB, FRCA, FCCM Paula F. Moon-Massat, DVM Aryeh Shander, MD Mazyar Javidroozi, MD A. Gerson Greenburg, MD 黄萍（译） 

机构地区：[1]Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland [2]Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey [3]Department of Surgery, Brown University, Providence, Rhode Island [4]Biopure Corporation, Cambridge, Massachusetts [5]不详

出　　处：《麻醉与镇痛》2011年第5期5-14,共10页Anesthesia & Analgesia

摘　　要：背景耶和华见证会（Jehovah’s Wilness）成员（拒绝输血）以及有输血禁忌证或缺乏血源时，治疗基础疾病的同时应用血红蛋白氧载体（HBOC）-201治疗能够改善急性贫血患者的存活率。方法在这项多中心、非盲态的系列研究中，对严重贫血患者实施标准治疗的同时，由无应用经验医生在专家指导下“特批”给予HBOC-201治疗，对影响生存率的因素加以分析。寻找转归的预测因素并在生存者和死亡者之间进行比较。采用一项复合物变量-血红蛋白缺乏持续时间乘积，描述贫血严重程度和持续时间与临床效果之间的相互影响。死亡率、患者一般特征之间的相关性以及出院生存率等信息由病历中获得。结果54例危重贫血患者（年龄中位数为50岁，血红蛋白浓度中位数为4g／d1）接受HBOC-20160—300g治疗，23例患者（41．8％）出院。围术期失血（45％）、恶性肿瘤（18％）和急性溶血（13％）是贫血的首要原因。生存者出现贫血（≤8g／d1）至HBOC-201输注的时间较非生存者短（3．2天vs4．4天，P=0．027）。输注HBOC之前生存者与死亡者血红蛋白平均水平分别为4．5g／dl和3．8g／dl（P=0．120）。HBOC-201的应用未产生严重的不良事件。血红蛋白缺乏持续时间乘积可用来区分生存者与死亡者。癌症与肾脏疾病和死亡相关。结论由无HBOC-201治疗经验的医生给予贫血患者HBOC-201治疗，及早应用可改善急性出血以及溶血患者的生存率。如果HBOC-201治疗前尽量缩短低血红蛋白血症的持续时间并尽可能降低贫血严重程度，可改善生存率。BACKGROUND： In consenting Jehovah＇s Witness patients and others for whom blood is contraindicated or not available, hemoglobin-based oxygen carrier （HBOC） -201 may enable survival in acutely anemic patients while underlying conditions are treated. METHODS： Survival factors were identified in a multicenter, unblinded series of severely anemic ＂compassionate use＂ patients receiving available standard treatment plus consultant-supported HBOC-201 administration by novice users. Predictors of outcome were sought and compared between survivors and nonsurvivors. A compound variable, hemoglobin-duration deficit product was used to describe the interactive clinical effects of severity and duration of anemia. Mor- tality, correlations between patient characteristics, and survival to hospital discharge were determined from patient records. RESULTS： Fifty-four patients （median age 50 years） with life-threatening anemia （median hemoglobin concentration at time of request = 4 g/dl） received 60 to 300 g HBOC-201. Twenty-three patients （41.8%） were discharged. Intraoperative blood loss （45%）, malignancy （18%）, and acute hemolysis （13%） were the prevailing reasons for anemia. Time fromonset of a- nemia （ ≤8 g/dl） to HBOC-201 infusion was shorter for survivors than nonsurvivors （3.2 vs 4.4 days, P = 0.027）. Mean hemoglobin levels before HBOC-201 infusion in survivors and nonsurvivors were 4.5 and 3.8 g/dl, respectively （P = 0. 120）. No serious adverse event was attributed to HBOC-201. The hemoglobin-duration deficit product separated survivors from non- survivors. Cancer and renal disease were associated with nonsurvival. CONCLUSIONS： Earlier, compared with later, admin- istration by inexperienced users of HBOC-201 to patients with anemia was associated with improved chances of survival of a- cutely bleeding and hemolyzing patients. Survival was more likely if the duration and magnitude of low hemoglobin was minimized before treatment with HBOC-201.

关 键 词：血红蛋白氧载体 贫血患者 生存率 应用 影响因素 输血 危重 标准治疗 

分 类 号：R457[医药卫生—治疗学]