超前口服补铁对营养不良患者膝关节置换术后贫血的影响  

Effect of preemptive oral iron supplementation on the recovery of anemia in malnutrition patients after total knee arthroplasty

作　　者：郝志鹏 徐凤周 刘永强 张双伟 吴涛 高学峰 HAO Zhipeng;XU Fengzhou;LIU Yongqiang(Department of Orthopedics,Shijiazhuang People’s Hospital,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市人民医院骨科,050000

出　　处：《河北医药》2024年第3期367-371,共5页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展计划(编号:211200823)。

摘　　要：目的观察超前口服铁剂对营养不良患者人工全膝关节置换术后贫血恢复进程的影响。方法收集预后营养指数(PNI)<45的膝关节置换未输血并术后常规联合应用重组人红细胞生成素(EPO)及蔗糖铁治疗的患者共89例,按住院前是否口服蛋白琥珀酸铁分为补铁组和对照组,补铁组患者自口服补铁至住院,时长1~28 d。调阅2组患者的年龄、性别、术前血红蛋白(Hb)、术后Hb恢复至术前HB的85%的具体时间等信息,并计算患者的失血量,应用方差分析对比术前2组患者Hb、RBC、HCT的差异,应用COX多因素回归分析服用不同时间铁剂对患者术后血红蛋白恢复“风险”的影响,从而探讨在营养不良人群超前补铁同术后贫血恢复进程的相关性。结果补铁组术前Hb、RBC、HCT高于对照组(P<0.05);超前口服补铁同术后恢复进程相关,补铁组术后血红蛋白达标“风险”高于对照组(P<0.05);调整混杂因素结果稳定;敏感性分析:超前补铁时间(≥14 d)相比对照组术前Hb增高,术后HB达标“风险”增加(P<0.05),调整混杂因素后结果稳定;超前口服补铁时间越长,术前HB越高,术后贫血恢复“风险”越大(P<0.05)。结论超前补铁≥14 d可以显著增加营养不良患者术前血红蛋白数值及加速膝关节置换术后贫血的恢复进程。Objective To observe the effect of preemptive oral iron supplementation on the recovery of anemia in malnutrition patients after total knee arthroplasty(TKA).Methods A total of 89 patients with prognostic nutritional index(PNI)who underwent TKA without blood transfusion and received conventional treatment with recombinant human erythropoietin(EPO)and iron saccharate were collected.They were divided into iron supplementation group and control group according to the supplementation of oral iron succinate before hospitalization or not.Patients in the iron supplementation group were hospitalized for 1-28 days from the date of oral iron supplementation.Information on age,gender,preoperative hemoglobin(Hb),and the specific time of postoperative Hb recovery to 85%of preoperative HB were recorded in both groups.Blood loss was calculated.Differences in Hb,red blood cell count(RBC)and hematocrit(HCT)between the two groups before surgery were compared by one-way ANOVA.The multivariate COX regression was applied to analyze the effect of different time of iron administration on the risk of hemoglobin recovery after surgery,thus investigating the correlation between the preemptive iron supplementation and the recovery process of postoperative anemia.Results Preoperative Hb,RBC and HCT were significantly higher in the iron supplementation group than that of the control group(P<0.05).Preemptive oral iron supplementation was significantly correlated with the postoperative recovery process.The risk of the postoperative hemoglobin compliance was significantly higher in the iron supplementation group than that of the control group(P<0.05)Results were stable after adjusting for confounding factors.Sensitivity analysis showed that the duration of preemptive iron supplementation of 14 days or longer in the iron supplementation group had a significantly higher preoperative Hb than that of control group,but a higher risk of the postoperative hemoglobin compliance(P<0.05).Results were stable after adjusting for confounding factors.The lon

关 键 词：全膝关节表面置换 超前补铁 重组人促红细胞生成素 蔗糖铁 预后营养指数 

分 类 号：R687.4[医药卫生—骨科学]