中国实用外科杂志

中国实用外科杂志

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rhEPO大剂量冲击维持疗法治疗肠瘘合并腹腔感染病人贫血的临床研究

洪之武，任建安，刘    颂，顾国胜，袁玉杰，周    波，闫冬升，黎介寿   

  1. 南京大学医学院临床学院 南京军区南京总医院普通外科，江苏南京210002
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    探讨重组人红细胞生成素（recombinant human erythropoietin，rhEPO）大剂量冲击维持疗法治疗肠瘘合并腹腔感染病人贫血的临床价值。 方法    选择2010年9月至2011年12月南京军区南京总医院肠瘘治疗病区114例肠瘘致腹腔感染伴贫血且资料完整的病例，按照机体含铁量情况分为机体铁含量正常组和机体铁缺乏组，同时铁含量正常组再次随机分为单纯营养支持治疗（enteral nutrition/parenteral nutrition，EN/PN）组和EN/PN联合大剂量rhEPO冲击维持治疗组（各30例）；铁缺乏组分为EN/PN联合铁剂（iron）组和EN/PN联合iron、大剂量rhEPO冲击维持治疗组（各27例）。入组病例全部给予足量EN/PN、rhEPO和（或）蔗糖铁注射剂治疗并进行疗效观察。 结果    两组病人治疗前后血红蛋白（Hb）比较，治疗前Hb差异无统计学意义（P>0.05）。体内含铁量正常病人，在rhEPO治疗组2周后Hb明显高于未实施rhEPO干预组（P<0.05）；体内含铁缺乏病人，铁剂联合rhEPO治疗组2周后Hb明显高于未实施rhEPO治疗组（P<0.05）。大多数病人耐受良好。 结论    肠瘘致腹腔感染伴贫血病人给予皮下注射rhEPO大剂量冲击维持疗法可有效快速提高病人的红细胞（RBC）及Hb水平，改善病人的贫血状况。该疗法耐受性较好，值得进一步扩大临床研究。

关键词: 重组人促红细胞生成素, 蔗糖铁, 肠瘘, 腹腔感染, 贫血

Abstract:

Clinical efficacy of high-dose induction therapy by maintenance with recombinant human erythropoietin(rhEPO) in intestinal fistula patients complicated with intra-abdominal infection with anemia        HONG Zhi-wu, REN Jian-an, LIU Song, et al. Department of General Surgery, School of Medicine, Nanjing University/Nanjing General Hospital of Nanjing Military Command, Nanjing210002, China
Corresponding  author ：REN Jian-an，E-mail:jan@medmail.com.cn
Abstract    Objective    To study clinical efficacy of recombinant human erythropoietin (rhEPO) in intestinal fistula patients complicated with intra-abdominal infection with anemia. Methods    One hundred and fourteen patients with intestinal fistula complicated with intra-abdominal infection with anemia admitted from September 2010 to December 2011 in General Hospital of Nanjing Military Command were enrolled. In accordance with the iron content of the body the patients were divided into the group with the normal iron content in the body and the group with the deficient iron content. The normal iron content group was randomly divided into nutrition support therapy group (n=30) and nutritional support combined with high-dose induction therapy by maintenance with rhEPO treatment group (n=30); iron deficiency group is divided into nutrition support therapy in combination with iron group (n=27) and nutrition support therapy in combination with iron, high-dose induction therapy by maintenance with rhEPO treatment group (n=27). All of the patients were given sufficient nutritional support, rhEPO and (or) iron sucrose injection treatment, and clinical observation was given. Results    There was no significant difference on hemoglobin between the two groups before treatment (P>0.05). After the intervention with rhEPO, the hemoglobin of the group with the normal iron content in the body was higher than in control group (P<0.05); the group with the deficient iron content in the body was higher than in control group (P<0.05). All patients demonstrated fine tolerance. Conclusion    The high-dose induction therapy by maintenance with rhEPO in intestinal fistula patients complicated with intra-abdominal infection with anemia can increase RBC and hemoglobin, relieve anemia with better treatment compliance, which is worth being studied further.

Key words: recombinant human erythropoietin (rhEPO), iron sucrose, intestinal fistula, intra-abdominal infection, anemia