Krafte-Jacobs B, Levetown M L, Bray G L, Ruttimann U E, Pollack M M
Department of Critical Care, Children's National Medical Center, Washington, DC 20010.
Crit Care Med. 1994 May;22(5):821-6. doi: 10.1097/00003246-199405000-00018.
To examine the endogenous erythropoietin response in critically ill children with acute anemia or acute hypoxemia.
A prospective case study of critically ill acutely anemic, and acutely hypoxemic pediatric patients compared with control groups of critically ill nonanemic and nonhypoxemic patients and with a hemoglobin and age-matched, chronically anemic patient group.
Multidisciplinary, tertiary, pediatric intensive care unit (ICU).
Critically ill patients admitted to the pediatric ICU during an 11-month period between February 1992 and March 1993 with acute anemia (n = 21), acute hypoxemia (n = 18), or neither anemia nor hypoxemia (n = 10). Outpatients with chronic anemia (n = 21) and no acute illness were also studied as a comparison group.
None.
Ages were equivalent among the groups and averaged 57.4 +/- 47.2 months (range 1 to 144). Acutely hypoxemic and critically ill control patients had normal hemoglobin levels. Acutely anemic patients had a hemoglobin level equivalent to chronically anemic outpatients, but lower (p < .001) hemoglobin levels than acutely hypoxemic and critically ill control patients. The serum erythropoietin concentrations in the acutely anemic group were significantly lower than erythropoietin values in the chronically anemic group (39.3 +/- 62.2 vs. 861 +/- 758 mU/mL, p < .001) and similar to erythropoietin concentrations in the critically ill control (13.5 +/- 10.5 mU/mL) and acutely hypoxemic (5.2 +/- 3.3 mU/mL) patient groups. Only ten of 49 critically ill patients had an erythropoietin concentration above normal, compared with 20 of 21 chronically anemic patients, whose erythropoietin concentrations were above normal.
The erythropoietin response to known physiologic stimuli is blunted in critically ill children. This blunted erythropoietin response may result in increased transfusion requirements.
研究患有急性贫血或急性低氧血症的危重症儿童的内源性促红细胞生成素反应。
一项对患有急性贫血、急性低氧血症的危重症儿科患者进行的前瞻性病例研究，并与非贫血和非低氧血症的危重症患者对照组以及血红蛋白和年龄匹配的慢性贫血患者组进行比较。
多学科、三级儿科重症监护病房（ICU）。
1992年2月至1993年3月的11个月期间入住儿科ICU的危重症患者，其中急性贫血患者（n = 21）、急性低氧血症患者（n = 18），以及既无贫血也无低氧血症的患者（n = 10）。患有慢性贫血且无急性疾病的门诊患者（n = 21）也作为对照组进行研究。
无。
各组年龄相当，平均为57.4±47.2个月（范围1至144个月）。急性低氧血症和危重症对照组患者的血红蛋白水平正常。急性贫血患者的血红蛋白水平与慢性贫血门诊患者相当，但低于急性低氧血症和危重症对照组患者（p <.001）。急性贫血组的血清促红细胞生成素浓度显著低于慢性贫血组（39.3±62.2对861±758 mU/mL，p <.001），与危重症对照组（13.5±10.5 mU/mL）和急性低氧血症组（5.2±3.3 mU/mL）患者的促红细胞生成素浓度相似。49例危重症患者中只有10例促红细胞生成素浓度高于正常，而21例慢性贫血患者中有20例促红细胞生成素浓度高于正常。
危重症儿童对已知生理刺激的促红细胞生成素反应减弱。这种促红细胞生成素反应减弱可能导致输血需求增加。
