促红细胞生成素治疗ICU危重患者贫血的临床对照研究

目的观察重组人促红细胞生成素（rhuEPO）治疗ICU危重患者贫血的疗效。方法将本院重症医学科（ICU）2009年4月～2011年10月收治的100例贫血患者随机分为观察组（n=50）和对照组（n=50）。两组患者均接受ICU常规治疗,观察组在常规治疗基础上加用rhuEPO,对照组在常规治疗基础上加用铁剂和维生素B12。观察并比较两组患者用药第1、7、14、21、28天外周静脉血血红蛋白（HB）、血细胞比容（HCT）、网织红细胞（RET）测值变化,输血率、ICU住院时间以及病死率。结果贫血相关指标显示,与治疗第1天相比,观察组患者RET计数逐渐上升,差异有统计学意义（P〈0.05）;对照组患者RET计数无明显变化,差异无统计学意义（P〉0.05）。两组患者HB、HCT均有所下降,但与同组治疗第1天测值比较差异均无统计学意义（P〉0.05）。组间比较显示,治疗第7、14、21、28天RET计数在观察组和对照组间差异均有统计学意义（P〈0.05）,HB、HCT在观察组和对照组间差异均无统计学意义（P〉0.05）。观察组输血率（48%）明显低于对照组（74%）,差异有统计学意义（P〈0.05）。观察组住院时间与对照组住院时间差异无统计学意义（P〉0.05）,观察组病死率（42%）低于对照组（48%）,但差异无统计学意义（P〉0.05）。结论 rhuEPO能够提高ICU贫血患者RET计数,维持HB、HCT的相对稳定,降低输血率。但rhuEPO并不能缩短ICU贫血患者的住院时间,也不能降低患者的病死率。从节约血源和减少输血风险的角度出发,可以考虑对ICU贫血患者使用rhuEPO。

Controlled clinical research of erythropoietin therapy for critically ill patients with anemia in intensive care unit

Objective To investigate the efficacy of recombinant human erythropoietin （rhuEPO） therapy for critically ill patients with anemia in intensive care unit. Methods One hundred critically ill patients with anemia admitted to intensive care unit of our hospital from April 2009 to October 2011 were enrolled and divided into observation group （n = 50） and control group （n = 50）. The peripheral venous blood hemoglobin （HB）, hematocrit （HCT）, reticulocyte （RET） measuring value change, blood transfusion rate, ICU length of hospital stay, and mortality after used 1, 7, 14, 21, 28 days were observed and compared between the two groups. Results Anemia related indicators, compared to the treatment of the first day, the patients＇ RET count gradually rose in observation group, the difference was statistically significant （P 0.05）; The patients＇ RET count had no significant change in control group, the difference was not statistically significant （P 0.05）. The HB, HCT were declined between the two groups, but with the same group therapy day 1 measuring value comparative differences were no statistical significance （P 0.05）. Between group comparison showed, Treatment of 7, 14, 21, 28 days, the RET count in the observation group and control group were statistically significant difference （P 0.05）, HB, HCT in the observation group and control group had not statistically significant difference （P 0.05）. The blood transfusion rate in observation group （48%） was significantly lower than that of the control group （74%）, the difference was statistically significant （P 0.05）. The difference was statistically significant of the hospitalization time between the observation group and control group（P 0.05）. The fatality rate in observation group （42%） was lower than that of the control group （48%）, but the difference was not statistically significant （P 0.05）. Conclusion rhuEPO can increase RET counts and keep HB, HCT relatively stable. rhuEPO can decrease blood transfusion rate, however, rhuEPO can not shorten length of stay in ICU and decrease mortality rate. In order to reduce blood transfusion, rhuEPO therapy for critically ill patients with anemia in intensive care unit is recommend.