红细胞生成素在瓣膜置换术中应用及量效关系.docVIP

红细胞生成素在瓣膜置换术中应用及量效关系 　【摘要】 目的探讨红细胞生成素在瓣膜置换术中应用的功效并寻找较佳量效关系。方法瓣膜置换手术45例，随机分成对照组、低剂量组和高剂量组。采用短周期治疗方案，低剂量组给药剂量300 IU/kg。高剂量组600 IU/kg，对照组不给重组人红细胞生成素。 结果（1）治疗组Hb、Ret值在治疗后持续显著高于对照组。高、低剂量组间Hb值在手术5天后差异无显著性。（2）治疗组输血量显著低于对照组，而出血量相似，高、低剂量组间输血量差异无显著性。手术2天后，治疗组无输血，对照组手术2天后输血率40%。结论（1） 本研究的短周期方案主要通过纠正体外循环手术后迟发性贫血来实现节血目的。（2）低剂量组的费用效能比较佳。 【关键词】 红细胞生成素;贫血;输血;瓣膜置换手术 　　Efficacy of Erythropoietin on the Patients Suffering Cardiac Valve Replacement and Dose- effectiveness Analysis 　　Abstract: OBJECTIVE This study is intended to identify the rational dose and to prove the efficacy of erythropoietin.METHODSForty-five patients with cardiac valve replacement were randomly divided into control group(n=15), high-dose group (600 IU/ kg,n=16)and low-dose group (300 IU/ kg,n=14). Erythropoietin was not administered in control group. RESULTS（1） The mean level of Hb and Ret in treatment groups are higher significantly than that of control group. But the difference of Hb between treatment groups is not significantly at the fifth postoperation day. （2） The mean units of transfusion between treatment groups and control group are statistically significant, But the difference between treatment groups is not significant. The mean blood loss between groups is not significant. The percentage of patients in control group who received transfusion in 2 days after operation were 40%, however no patients need transfusion in treatment groups in 2 days after operation. CONCLUSION（1） The saving of blood is achieved mainly by the cure of delayed anemia. （2） The low-dose method’s cost- effectiveness is better than high- dose method. 　　Key words：Erythropoietin; Anemia;Transfusion;Valve replacement 　　体外循环（Extracorporeal circulation，ECC）手术易发生围术期贫血。应用重组人红细胞生成素预防和纠正围术期贫血，并就其红细胞动员的功效以及较佳的量效关系进行了研究，报告如下。 　　1资料与方法 　　1.1病例选择和分组 　　将2002年12月至2004年4月间一般情况好，无感染、贫血、代谢障碍及风湿活动且心功能III级，择期行瓣膜置换手术的风湿性心脏病成年患者45例，随机分成对照组（n=15）、低剂量组（n=14,300 IU/㎏）和高剂量组（n=16,600 IU/㎏）。其中男21例，女24例。年龄18～61岁。 　　1.2ECC方法 　　采用德国Stockert II型ECC机，（希健-Ⅱ型）膜式氧合器