重组人红细胞生成素治疗老年髋部骨折围手术期贫血的效果研究

叶小龙 马遇伯

[摘要] 目的 研究重組人红细胞生成素（Recombinant human erythropoietin，rhEPO）对全髋关节置换术后失血性贫血的治疗效果。 方法 选取2018年6～12月48例单侧全髋关节置换患者进行实验。随机分为实验组和对照组，实验组术前使用rhEPO，且用药期同时补铁;对照组不使用rhEPO，仅补铁。用药及手术前后都须检测两组患者的网织红细胞、血红蛋白、红细胞压积。实验组同时检测血压、血小板、血钾及谷丙转氨酶和尿素氮的含量。 结果 实验组的网织红细胞、血红蛋白和红细胞压积检测值用药后不同时间点均比对照组高，差异有统计学意义（P<0.05）。实验组患者的谷丙转氨酶和血钾、血压和血小板及尿素氮测定值治疗前后除血钾和尿素氮有统计学差异外（P<0.05，但仍属于正常值范围），其余均无统计学差异（P>0.05）。用药后，实验组出现1例皮疹，2例注射部位疼痛，均自行减缓。 结论 全髋关节置换患者围手术期使用rhEPO能较好预防和改善患者贫血状况，具有良好的耐药性。rhEPO能促进原红细胞分裂增殖并维持其活力，治疗期间需同时补铁。

[关键词] 重组人红细胞生成素;髋部骨折围手术期;贫血;单侧全髋关节置换术

[中图分类号] R683.4          [文献标识码] B          [文章编号] 1673-9701（2020）18-0104-06

A study of the effect of recombinant human erythropoietin in the treatment of perioperative anemia of hip fracture in the elderly

YE Xiaolong1   MA Yubo2

1.Mudanjiang Medical University， Mudanjiang 157000， China; 2.Department of Osteology， Hongqi Hospital Affiliated to Mudanjiang Medical University， Mudanjiang 157000， China

[Abstract] Objective To study the therapeutic effect of recombinant human erythropoietin （rhEPO） on hemorrhagic anemia after total hip arthroplasty. Methods 48 patients with unilateral total hip arthroplasty from June to December 2018， were selected for the experiment and were divided into experimental group and control group. The experimental group was administered rhEPO before operation， and iron was supplemented at the same time of medication. The control group was not administered rhEPO and was only given iron supplementation. It was made sure that reticulocyte， hemoglobin and hematocrit of the two groups of patients be tested before and after medication and operation. In addition to them， blood pressure， platelet， blood potassium， the contents of glutamic pyruvic transaminase and BUN were simultaneously tested in the experimental group. Results The test values of reticulocyte， hemoglobin and hematocrit in the experimental group were higher than those in the control group at different time points after administration， and the difference was statistically significant（P<0.05）. Among the values of glutamic pyruvic transaminase and blood potassium， blood pressure， platelet and urea nitrogen of the patients in the experimental group， except blood potassium and urea nitrogen which showed statistically significant difference（P<0.05 but still within the normal range）， all had no statistical difference （P>0.05）. After medication， 1 case of rash and 2 cases of pain at the injection site appeared in the experimental group， which were both alleviated by time and without intervention. Conclusion An administration of rhEPO to patients undergoing total hip arthroplasty during perioperative period can effectively prevent and ameliorate anemia in patients， and the drug resistance is optimistic. RhEPO can promote the division and proliferation of erythrocytes and maintain their vitality.Iron supplementation is required during the treatment.

[Key words] Recombinant human erythropoietin （rhEPO）; Perioperative period of hip fracture; Anemia; Unilateral total hip arthroplasty

髋部骨折好发于老年人，近年来我国人口老龄化形势严峻，髋部骨折患者数量逐年递增[1]。目前，针对老年群体进行手术是治疗髋部骨折最有效的方法。髋部骨折在临床上多选用择期手术而非急诊手术，先对老年患者进行全面检查，才能更好地促进术后恢复[2]。多数患者术后鲜有显性失血情况，但隐性失血隐患较大，易造成贫血，严重影响患者的恢复。另外，Hamid R等[3]对204例60岁及以上的髋关节骨折患者进行回顾性分析，结果表明，髋部骨折死亡率为24%，年龄增长会提高死亡率。……