Madi-Jebara Samia N, Sleilaty Ghassan S, Achouh Paul E, Yazigi Alexandre G, Haddad Fadia A, Hayek Gemma M, Antakly Marie-Claire J, Jebara Victor A
Department of Anesthesiology, Université Saint Joseph Beirut, Lebanon.
J Cardiothorac Vasc Anesth. 2004 Feb;18(1):59-63. doi: 10.1053/j.jvca.2003.10.012.
The aim of this study was to examine whether intravenous iron III-hydroxide sucrose complex (IHSC) used alone was sufficient to provide rapid correction of anemia after cardiac surgery and whether additional stimulation of erythropoiesis is possible by means of a single low dose of recombinant-human erythropoietin (r-HuEPO) administration.
Prospective, randomized, double-blind study.
The study was conducted in a university hospital.
One hundred twenty American Society of Anesthesiologists II or III patients, who underwent elective cardiac surgery using cardiopulmonary bypass and in whom postpump hemoglobin ranged between 7 and 10 g/dL.
Patients were divided into 3 groups: group I = control; group II received postoperative intravenous iron supplementation with an iron III-hydroxide sucrose complex (IHSC); and group III received IV iron and a single dose of r-HuEPO (300 U/kg).
No significant difference in transfusion needs was observed among the 3 groups (22%, 25%, and 17% of patients transfused in groups I, II, and III, respectively). Hemoglobin levels, reticulocyte counts, and serum ferritin levels were evaluated at different time intervals (until day 30 postoperatively). No side effects because of iron administration were noted in the study. Reticulocyte counts increased rapidly at day 5 (2.24% +/- 1.11%, 1.99% +/- 1.44%, and 3.84% +/- 2.02% in groups I, II, and III, respectively) and decreased after day 15 in the 3 groups. Ferritin levels increased significantly at day 5 in the 2 treated groups (899.33 +/- 321.55 ng/mL in group II, 845.75 +/- 289.96 ng/mL in group III v 463.15 +/- 227.74 ng/mL in group I). In group I, ferritin levels, after a slight elevation on day 5, decreased at day 15 to lower than baseline levels. No significant difference in hemoglobin increase was noted among the 3 groups.
Postoperative intravenous iron supplementation alone or in combination with a single dose of r-HuEPO (300 U/kg) is not effective in correcting anemia after cardiac surgery.
本研究旨在探讨单独使用静脉注射氢氧化铁III-蔗糖复合物（IHSC）是否足以在心脏手术后迅速纠正贫血，以及单次低剂量给予重组人促红细胞生成素（r-HuEPO）是否有可能额外刺激红细胞生成。
前瞻性、随机、双盲研究。
该研究在一家大学医院进行。
120例美国麻醉医师协会II级或III级患者，他们接受了使用体外循环的择期心脏手术，且术后血红蛋白水平在7至10 g/dL之间。
患者分为3组：I组为对照组；II组术后接受静脉注射铁剂补充，使用氢氧化铁III-蔗糖复合物（IHSC）；III组接受静脉注射铁剂并单次给予r-HuEPO（300 U/kg）。
3组之间在输血需求方面未观察到显著差异（I组、II组和III组分别有22%、25%和17%的患者接受输血）。在不同时间间隔（直至术后30天）评估血红蛋白水平、网织红细胞计数和血清铁蛋白水平。研究中未观察到因铁剂给药引起的副作用。网织红细胞计数在第5天迅速增加（I组、II组和III组分别为2.24%±1.11%、1.99%±1.44%和3.84%±2.02%），并在第15天后在3组中均下降。2个治疗组的铁蛋白水平在第5天显著升高（II组为899.33±321.55 ng/mL，III组为845.75±289.96 ng/mL，而I组为463.15±227.74 ng/mL）。在I组中，铁蛋白水平在第5天略有升高后，在第15天降至低于基线水平。3组之间在血红蛋白增加方面未观察到显著差异。
术后单独静脉注射铁剂或与单次剂量的r-HuEPO（300 U/kg）联合使用在纠正心脏手术后的贫血方面无效。
