Moral García Victoria, Ángeles Gil de Bernabé Sala M, Nadia Diana Kinast, Pericas Bartolomé Cantallops, Nebot Alexia Galindo
Servicio de Anestesiología, Clínica del Dolor, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España.
Med Clin (Barc). 2013 Jul;141 Suppl 1:47-54. doi: 10.1016/S0025-7753(13)70053-8.
Perioperative anemia is common in patients undergoing surgery and is associated with increased morbidity and mortality and a decreased quality of life. The main causes of anemia in the perioperative context are iron deficiency and chronic inflammation. Anemia can be aggravated by blood loss during surgery, and is most commonly treated with allogeneic transfusion. Moreover, blood transfusions are not without risks, once again increasing patient morbidity and mortality. Given these concerns, we propose to review the pathophysiology of anemia in the surgical environment, as well as its treatment through the consumption of iron-rich foods and by oral or intravenous iron therapy (iron sucrose and iron carboxymaltose). In chronic inflammatory anemia, we use erythropoiesis-stimulating agents (erythropoietin alpha) and, in cases of mixed anemia, the combination of both treatments. The objective is always to reduce the need for perioperative transfusions and speed the recovery from postoperative anemia, as well as decrease the patient morbidity and mortality rate.
围手术期贫血在接受手术的患者中很常见,与发病率和死亡率增加以及生活质量下降相关。围手术期贫血的主要原因是缺铁和慢性炎症。手术期间的失血会加重贫血,最常见的治疗方法是异体输血。此外,输血并非没有风险,这再次增加了患者的发病率和死亡率。鉴于这些问题,我们建议回顾手术环境中贫血的病理生理学,以及通过食用富含铁的食物和口服或静脉注射铁剂治疗(蔗糖铁和羧基麦芽糖铁)。在慢性炎症性贫血中,我们使用促红细胞生成剂(α-促红细胞生成素),在混合性贫血的情况下,则联合使用这两种治疗方法。目标始终是减少围手术期输血的需求,加速术后贫血的恢复,并降低患者的发病率和死亡率。