红细胞生成素联合铁剂治疗股骨粗隆间骨折围手术期贫血的疗效分析

摘要

目的 分析红细胞生成素联合铁剂治疗粗隆间骨折患者围手术期贫血的安全性和有效性.方法 前瞻性研究2014年5月至2016年5月在本院住院行手术治疗的单侧新鲜股骨粗隆间骨折患者112例,随机分为观察组和对照组,其中观察组57例,对照组55例,记录并比较2组患者术前等待时间、手术时间、术中失血量、术中及术后输血人数及输血量;记录并比较2组患者入院时、术前、术后第1、3、5天清晨空腹时Hb及Hct;比较2组患者伤口感染、肺部感染、泌尿系统感染、深静脉血栓及肺栓塞等不良反应.结果 2组患者术前等待时间、手术时间、术中失血量及围手术期失血量差异无统计学意义(P＞0.05).围手术期观察组有4例接受输血治疗(7％,4/57),对照组有12例接受输血治疗(21％,12/55),2组差异有统计学意义(P=0.01);观察组平均输血量为(2.4±0.85)u,对照组为(2.5 ±0.82)u,2组差异无统计学意义(P＞0.05).2组患者在术后第3天Hb及Hct下降最明显,术后第3、5天观察组Hb明显高于对照组,差异有统计学意义(P＜0.05);观察组在术前、术后Hct均较高,差异有统计学意义(P＜0.01).2组患者均无感染、深静脉血栓及肺栓塞发生.结论 红细胞生成素联合铁剂治疗粗隆间骨折患者围手术期贫血安全而且有效,能明显减少患者围手术期输血率,同时并不增加感染、深静脉血栓及肺栓塞发生率.%Objective To analyze the efficacy and safety of erythropoietin combined with chalybeate in the treatment of perioperative anemia in patients with femoral intertrochanteric fracture.Methods A total of 112 patients with femoral intertrochanteric fracture who were treated by PFNA from May 2014 and May 2016 in our hospital were enrolled in this prospective study.They were divided into the treatment group (57 patients) and the control group (55 patients).The following data were recorded and compared:preoperative waiting time,operation time,intraoperative blood loss,number and volume needed blood transfusion at intraoperative and postoperative,the value of Hb and Hct on admission,before operation,1 st,3rd and 5th day after operation,the wound infection,pulmonary and urinary infection,deep vein thrombosis and plumonary embolism.Results There was no significant difference between the two groups in preoperative waiting time,operation time,intraoperative blood loss and perioperative blood loss (P ＜ 0.05).Treatment group has less patients (7％,4/57) in transfusion compared with control group (21％,12/55),and the difference was significant (P =0.01).There was no significant difference in the average volume of transfusion between the treatment group [(2.4 ±0.85)u] and the control group [(2.5 ±0.82)u].The value of Hb and Hct were most significantly decreased at the 3rd day after operation in both of the two groups,and they exceed the control group at the 3rd and 5th day after operation compared with the treatment group with significant difference(P ＜ 0.05).Treatment group has higher value of Hct at pre-and postoperative compared with that of the control group (P ＜ 0.01).There was no infection,deep vein thrombosis and plumonary embolism occurred in the to groups.Conclusion Erythropoietin combined with chalybeate in the treatment of perioperative anemia during femoral intertrochanteric fracture is a safe and effective method which can significantly reduce the rate of perioperative blood transfusion,while not increasing infection,deep vein thrombosis and plumonary embolism.