MacLean Beth, Weyand Angela, Lim Jayne, Richards Toby
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Division of Hematology-Oncology, Department of Pediatrics, University of Michigan Medical School, Michigan, USA.
Best Pract Res Clin Anaesthesiol. 2023 Dec;37(4):503-510. doi: 10.1016/j.bpa.2023.10.003. Epub 2023 Oct 16.
Preoperative anemia affects one-third of patients undergoing major surgery and is associated with worse perioperative and postoperative outcomes; including length of hospital stay, allogeneic blood transfusion, morbidity, and mortality. Iron deficiency is the most common cause of anemia, and associative data suggests that preoperative correction of iron deficiency anemia could improve postoperative patient outcomes. However, data from randomized controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anemia. We present a literature review of large RCTs examining the efficacy of preoperative intravenous iron. We discuss the observation that although preoperative intravenous iron treatment can increase hemoglobin concentration prior to surgery in certain patient groups, the data do not clarify whether there is a direct benefit to patients. We address that preoperative intravenous iron may not be a feasible option and highlight the need to explore the mechanism and management of iron deficiency anemia in surgical patients.
术前贫血影响着三分之一接受大手术的患者，并与围手术期和术后更差的结果相关，包括住院时间、异体输血、发病率和死亡率。缺铁是贫血最常见的原因，相关数据表明术前纠正缺铁性贫血可改善术后患者的预后。然而，随机对照试验（RCT）的数据似乎并不支持常规使用铁剂治疗术前贫血。我们对大型RCT进行了文献综述，以研究术前静脉补铁的疗效。我们讨论了这样一个观察结果，即虽然术前静脉补铁治疗在某些患者群体中可在手术前提高血红蛋白浓度，但数据并未阐明这对患者是否有直接益处。我们指出术前静脉补铁可能不是一个可行的选择，并强调需要探索外科患者缺铁性贫血的机制和管理方法。
