促红细胞生成素对不同年龄关节置换患者围术期贫血的影响  

Study on the Efficacy of Erythropoietin in the Treatment of Perioperative Anemia in Patients with Joint Replacement of Different Ages

作　　者：安帅[1] 李佳义 李征[1] 武京伟[1] 曹光磊[1] 冯明利[1] 沈惠良[1] 刘利民[1] 鲁世保[1] An Shuai;Li Jiayi;Li Zheng(Department of Orthopaedics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《实用骨科杂志》2020年第8期688-692,共5页Journal of Practical Orthopaedics

基　　金：宣武医院院级课题(XWJL-2019033);首都卫生发展科研专项项目(首发2020-4-2018)。

摘　　要：目的探讨促红细胞生成素(erythropoietin,EPO)联合应用铁剂对不同年龄髋膝关节置换术患者术后贫血的影响。方法回顾性分析2013年5月至2014年12月于我院治疗的全髋关节置换术(total hip arthroplasty,THA)和全膝关节置换术(total knee arthroplasty,TKA)患者149例;男42例,女107例;年龄51~92岁,平均(72.8±8.52)岁。髋关节置换术74例,膝关节置换术75例。根据患者年龄分为老年组121例(≥65岁)和非老年组28例(<65岁),两组患者围术期均采用EPO联合应用铁剂的血液管理方法。记录患者基本信息和围手术期化验指标、手术前后贫血率、异体输血率、失血量等数据,利用Nadler方程计算患者血容量、Gross方程计算患者隐性失血量,进行统计学分析比较。结果术前贫血率:老年组24.0%,高于非老年组的7.1%,差异有统计学意义(P<0.05);手术后1、3、5 d血红蛋白(hemoglobin,Hb)下降水平:老年组23(12,30)g/L、29(18,38)g/L、26(15,37)g/L,均低于非老年组的30(22,36)g/L、38(29,49)g/L、32(23,45)g/L,差异均有统计学意义(P<0.05);异体输血率:老年组为43.8%,显著高于非老年组的21.4%,差异有统计学意义(P<0.05);失血情况:老年组总失血量1120(831,1483)mL、隐性失血量686(430,1066)mL、隐性失血比例61(51,75)%、显性失血量400(300,500)mL,非老年组分别为1087(821,1480)mL、505(414,1116)mL、61(45,74)%、440(205,558)mL,两组比较差异均无统计学意义(P>0.05)。结论老年关节置换患者术前贫血率、异体输血率及输血量相比非老年患者较高;EPO联合铁剂的血液管理效果对老年人不佳。Objective To investigate the effect of erythropoietin(EPO)combined with iron on anemia after hip and knee arthroplasty in different ages.Methods 149 patients with total hip arthroplasty(THA)and total knee arthroplasty(TKA)treated in XuanwuHospital of Capital Medical University were analyzed from May 2013 to December 2014,retrospectively.There were 42 males and 107 females,aged from 51 to 92 years old,with an average of(72.8±8.52)years old.Hip arthroplasty was performed in 74 cases and knee arthroplasty in 75 cases.According to the age of the patients,the patients were divided into two groups:the elderly group(≥65 years old,n=121)and the non-elderly group(<65 years old,n=28).The patients in both groups were treated with EPO combined with iron during the perioperative period.The baseline information of patients,perioperative laboratory indexes,anemia rate before and after operation,allogeneic blood transfusion rate and blood loss volume were recorded.The blood volume of patients was calculated by Nadler equation and the hidden blood loss volume was calculated by Gross equation for statistical analysis.Results The preoperative anemia rate in the elderly group was 24.0%,which was significantly higher than 7.1%in the non-elderly group(P<0.05).The decrease level of hemoglobin(Hb)on the 1st,3rd and 5th day before and after operation in the elderly group was 23(12,30)g/L、29(18,38)g/L、26(15,37)g/L,respectively,which was significantly lower than that in the non-elderly group 30(22,36)g/L、38(29,49)g/L、32(23,45)g/L(P<0.05).The rate of allogeneic blood transfusion:43.8%,in the elderly group were significantly higher than those in the non-elderly group 21.4%(P<0.05).Blood loss:the total blood loss in the elderly group was 1120(831,1483)vs 1087(821,1480)mL,hidden blood loss 686(430,1066)vs 505(414,1116)mL,hidden blood loss ratio 61(51,75)vs 61(45,74)%,dominant blood loss 400(300,500)vs 440(205,558)mL,the difference was not statistically significant(P>0.05).Conclusion The preoperative anemia rate,allogeneic blood tran

关 键 词：促红细胞生成素 关节置换 老年 贫血 

分 类 号：R687.42[医药卫生—骨科学]