Department of Cardiology, Hospital del Mar (Parc de Salut Mar), Department of the Medicine Universitat Autònoma de Barcelona, Barcelona, Spain.
Am J Cardiol. 2012 Oct 1;110(7):1021-6. doi: 10.1016/j.amjcard.2012.05.036. Epub 2012 Jul 7.
Preoperative anemia is a risk factor for postoperative morbidity and in-hospital mortality in cardiac surgery. However, it is not known whether treatment of anemia before cardiac surgery by administering recombinant human erythropoietin (rhEPO) plus iron improves postoperative outcomes and decreases red blood cell transfusions in these patients. In 1998 a collection of consecutive data for patients who underwent valve replacement was initiated and the inclusion criterion was anemia. Treatment with rhEPO was given at a dose of 500 IU/kg/day every week for 4 weeks and the fifth dose 48 hours before valve replacement. During each rhEPO session, patients received intravenous iron sucrose supplementation. The intervention cohort (2006 to 2011) included 75 patients and the observation cohort was composed of 59 patients who did not receive any treatment (1998 to 2005). Multivariable logistic regression analysis showed that administration of combined therapy was independently associated with decreased postoperative morbidity (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.03 to 0.59 p = 0.008) and in-hospital mortality (OR 0.16, 95% CI 0.28 to 0.95 p = 0.04) after adjusting for logistic European System for Cardiac Operative Risk Evaluation score, type of intervention, time of cardiopulmonary bypass, and year of surgery. Individually, this treatment also decreased postoperative renal failure (OR 0.23, 95% CI 0.06 to 0.88, p = 0.03). Rate of red blood cell transfusion decreased from 93% in the observation cohort to 67% in the intervention cohort as did days of hospitalization (median, 15 days, 10 to 27, versus 10 days, 8 to 14, respectively, p = 0.01 for all comparisons). In conclusion, administration of intravenous rhEPO plus iron in anemic patients before valve replacement improves postoperative survival, decreases blood transfusions, and shortens hospitalization.
术前贫血是心脏手术后发病率和住院死亡率的一个危险因素。然而，目前尚不清楚在心脏手术前通过给予重组人促红细胞生成素（rhEPO）加铁来治疗贫血是否能改善这些患者的术后结局并减少红细胞输注。1998 年开始对接受瓣膜置换术的患者进行连续数据采集，纳入标准为贫血。rhEPO 治疗剂量为每周 500IU/kg，共 4 周，第五剂在瓣膜置换术前 48 小时给予。在每次 rhEPO 疗程中，患者接受静脉铁蔗糖补充。干预组（2006 年至 2011 年）包括 75 例患者，观察组由 59 例未接受任何治疗的患者组成（1998 年至 2005 年）。多变量逻辑回归分析显示，联合治疗的应用与术后发病率降低（比值比 [OR] 0.13，95%置信区间 [CI] 0.03 至 0.59，p = 0.008）和住院死亡率降低（OR 0.16，95%CI 0.28 至 0.95，p = 0.04）独立相关，调整了逻辑欧洲心脏手术风险评估评分、干预类型、体外循环时间和手术年份后。单独来看，这种治疗还降低了术后肾衰竭的发生率（OR 0.23，95%CI 0.06 至 0.88，p = 0.03）。观察组的红细胞输注率从 93%降至 67%，观察组的住院时间中位数也从 15 天（10 至 27 天）降至 10 天（8 至 14 天），所有比较的 p 值均为 0.01。总之，在瓣膜置换术前对贫血患者给予静脉 rhEPO 加铁可改善术后生存，减少输血，并缩短住院时间。
