Tramarin Roberto, Pistuddi Valeria, Maresca Luigi, Pavesi Marco, Castelvecchio Serenella, Menicanti Lorenzo, de Vincentiis Carlo, Ranucci Marco
1 Department of Perioperative Cardiology and Cardiac Rehabilitation, IRCCS Policlinico San Donato, Italy.
2 Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Italy.
Eur J Prev Cardiol. 2017 May;24(8):799-807. doi: 10.1177/2047487317689975. Epub 2017 Jan 24.
Background Anaemia and iron deficiency are frequent following major surgery. The present study aims to identify the iron deficiency patterns in cardiac surgery patients at their admission to a cardiac rehabilitation programme, and to determine which perioperative risk factor(s) may be associated with functional and absolute iron deficiency. Design This was a retrospective study on prospectively collected data. Methods The patient population included 339 patients. Functional iron deficiency was defined in the presence of transferrin saturation <20% and serum ferritin ≥100 µg/l. Absolute iron deficiency was defined in the presence of serum ferritin values <100 µg/l. Results Functional iron deficiency was found in 62.9% of patients and absolute iron deficiency in 10% of the patients. At a multivariable analysis, absolute iron deficiency was significantly ( p = 0.001) associated with mechanical prosthesis mitral valve replacement (odds ratio 5.4, 95% confidence interval 1.9-15) and tissue valve aortic valve replacement (odds ratio 4.5, 95% confidence interval 1.9-11). In mitral valve surgery, mitral repair carried a significant ( p = 0.013) lower risk of absolute iron deficiency (4.4%) than mitral valve replacement with tissue valves (8.3%) or mechanical prostheses (22.5%). Postoperative outcome did not differ between patients with functional iron deficiency and patients without iron deficiency; patients with absolute iron deficiency had a significantly ( p = 0.017) longer postoperative hospital stay (median 11 days) than patients without iron deficiency (median nine days) or with functional iron deficiency (median eight days). Conclusions Absolute iron deficiency following cardiac surgery is more frequent in heart valve surgery and is associated with a prolonged hospital stay. Routine screening for iron deficiency at admission in the cardiac rehabilitation unit is suggested.
大手术后贫血和缺铁情况较为常见。本研究旨在确定心脏手术患者在进入心脏康复项目时的缺铁模式，并确定哪些围手术期危险因素可能与功能性缺铁和绝对性缺铁相关。
这是一项对前瞻性收集的数据进行的回顾性研究。
患者群体包括339名患者。功能性缺铁定义为转铁蛋白饱和度<20%且血清铁蛋白≥100μg/L。绝对性缺铁定义为血清铁蛋白值<100μg/L。
62.9%的患者存在功能性缺铁，10%的患者存在绝对性缺铁。在多变量分析中，绝对性缺铁与机械瓣膜二尖瓣置换术显著相关（p = 0.001）（比值比5.4，95%置信区间1.9 - 15）以及组织瓣膜主动脉瓣置换术（比值比4.5，95%置信区间1.9 - 11）。在二尖瓣手术中，二尖瓣修复的绝对性缺铁风险（4.4%）显著低于组织瓣膜二尖瓣置换术（8.3%）或机械瓣膜二尖瓣置换术（22.5%）（p = 0.013）。功能性缺铁患者与无缺铁患者的术后结局无差异；绝对性缺铁患者的术后住院时间（中位数11天）显著长于无缺铁患者（中位数9天）或功能性缺铁患者（中位数8天）（p = 0.017）。
心脏手术后的绝对性缺铁在心脏瓣膜手术中更为常见，且与住院时间延长相关。建议在心脏康复单元入院时对缺铁进行常规筛查。
