Kyo S, Omoto R, Hirashima K, Eguchi S, Fujita T
First Department of Surgery, Saitama Medical School, Japan.
Circulation. 1992 Nov;86(5 Suppl):II413-8.
Recombinant human erythropoietin (EPOCH) has been shown to increase erythropoiesis; therefore, EPOCH has been used in conjunction with autologous blood predonation (ABP) before surgery. However, the administration methods of EPOCH to obtain an adequate volume of ABP before open-heart surgery have not been determined.
The effects of EPOCH on harvesting ABP and decreasing homologous blood transfusion (HBT) in open-heart surgery were examined prospectively in 205 patients treated in a 29-institute multicenter study. Single dose of 3,000, 6,000, or 9,000 IU of EPOCH were administered for 2 weeks (two or three times per week) without ABP (group 1, n = 69) or for 3 weeks (two or three times per week) with ABP (group 2, n = 97) and compared with control subjects (n = 39). Preoperative blood hemoglobin increase (delta Hb[g/dl]) was < 1.0 g/dl in group 1. When EPOCH was given three times a week, the delta Hb in each subgroup of group 2 was 0.6 +/- 1.1 (control), 2.1 +/- 1.3 (3,000 IU), 2.4 +/- 1.4 (6,000 IU), and 2.8 +/- 1.5 (9,000 IU), which was significantly higher than the control (p < 0.05) and was dose dependent. The HBT rates in patients with a moderate perioperative blood loss of between 15 and 50 ml/kg were 75.0% (control), 35.7% (3,000 IU), 52.9% (6,000 IU), and 66.7% (9,000 IU) in group 1, and respective volumes in group 2 were 40.0% (control), 20.0% (3,000 IU), 26.9% (6,000 IU), and 12.5% (9,000 IU). The overall HBT rate of EPOCH-treated patients with a moderate blood loss was 50% (20 of 40) in group 1 and 21% (13 of 62) in group 2. The HBT rate was significantly reduced by combination of preoperative EPOCH treatment (three times per week) and ABP (p < 0.0001).
Dose-dependent increase of blood hemoglobin level was observed by EPOCH treatment with ABP; combination of EPOCH treatment and ABP can reduce HBT during open-heart surgery.
重组人促红细胞生成素（EPOCH）已被证明可促进红细胞生成；因此，EPOCH已被用于在手术前与自体血预存（ABP）联合使用。然而，在心脏直视手术前获得足够量ABP的EPOCH给药方法尚未确定。
在一项由29家机构参与的多中心研究中，对205例接受治疗的患者进行前瞻性研究，以检验EPOCH对心脏直视手术中采集ABP和减少异体输血（HBT）的效果。单剂量3000、6000或9000国际单位的EPOCH在无ABP的情况下给药2周（每周两次或三次）（第1组，n = 69），或在有ABP的情况下给药3周（每周两次或三次）（第2组，n = 97），并与对照组（n = 39）进行比较。第1组术前血红蛋白增加量（δHb[g/dl]）<1.0 g/dl。当每周三次给予EPOCH时，第2组各亚组的δHb分别为0.6±1.1（对照组）、2.1±1.3（3000国际单位）、2.4±1.4（6000国际单位）和2.8±1.5（9000国际单位），显著高于对照组（p<0.05），且呈剂量依赖性。围手术期失血15至50 ml/kg的患者中，第1组的HBT率分别为75.0%（对照组）、35.7%（3000国际单位）、52.9%（6000国际单位）和66.7%（9000国际单位），第2组的相应比例分别为40.0%（对照组）、2缉0.0%（3000国际单位）、26.9%（6000国际单位）和12.5%（9000国际单位）。第1组中失血程度适中的EPOCH治疗患者的总体HBT率为50%（40例中的20例），第2组为21%（62例中的13例）。术前EPOCH治疗（每周三次）与ABP联合使用可显著降低HBT率（p<0.0001）。
通过EPOCH与ABP联合治疗观察到血红蛋白水平呈剂量依赖性升高；EPOCH治疗与ABP联合使用可减少心脏直视手术期间的HBT。
