重组人类红细胞生成素纠正心脏直视手术后贫血的可行性研究

目的了解手术失血对病人自体促红细胞生成素的影响，通过动物实验证实生理条件下应用基因重组人类促红细胞生成素(rhEPO)的作用及对血液粘稠度的影响，将重组人类促红细胞生成素应用于心脏手术后早期纠正贫血，促进病人迅速恢复。方法术前无贫血、术中中等量失血、术后未输血择期外科手术病人10例(EPO组)，测定其术前、术后1、2、4、6、8天EPO及Hct变化。健康家兔6只，用rhEPO300IU共2周，监测给药前、给药后3、6、12、13、21天Hb、Hct、RBC变化及监测血清ALT、血清K+、血浆粘度和全血粘度变化。心脏手术后贫血(Hb＜100g/L)病人6例(给药组),应用rhEPO300IU连续两周，观察给药前后Hb、Hct变化。结果EPO组术后血清EPO立即上升,术后第1～2天达到高峰后下降，但与术前比较仍呈显著性升高。Hct术后下降，至术后8天无明显上升。家兔用药后第12天Hb、Hct、RBC明显升高，血清ALT、血清K+无显著改变，血浆粘度和全血粘度无明显升高。术后给药组患者Hb、Hct升高，给药后第14天Hb升高与术前无显著性差异，而Hct增加与给药前比较有显著差异P＜0．05。结论应用rhEPO纠正心脏术后贫血安全有效,可避免异体输血和因贫血造成组织供氧降低而产生的并发症。

The Effect of Recombinant Human Erythropoietin on Postoperative Anemia in Cardiac Surgery Patients

Objective:To observe the change of endogenous erythropoietin(EPO) in patients undergoing elective major surgeries and the impact of recombinant human erythropoietin(rhEPO) on blood viscosity of animalsunder normal physiologic al conditions. In addition, the effect of rhEPO on postoperative anemia in cardiac surgery patients was evaluated. Methods:Ten patients scheduled for elective major procedures were studied. Included criteria were no preoperative anemia, moderate intraoperative blood loss and no postoperative transfusion. Serum EPO levers were measured prior to operation, immediately after the operation, as well as on postoperative days(PODs) 1, 2, 4, 6, 8. The change of Hct was measured too. (EPO group) Six adult rabbits received 300IU/kg of rhEPO weekly for two weeks. Specimens of Hb, Hct, RBC, serum ALT, serum potassium and blood viscosity were obtained before, during and after administration of rhEPO. Six patients with postoperative anemia (Hb＜100g/L) who underwent cardiac surgeries received 300IU/kg of rhEPO weekly for two weeks. The changes of Hb,Hct were compared(rhEpO group). Results: In EPO group serum EPO concentration increased immediately after the operation, reached a peak level during 24-48h postoperatively and remained significantly elevated above the operative value until POD 8. Hct significantly declined after the operation and was still significantly lower than the preoperative value on POD 8.On the 12th day after applying rhEPO, Hb, Hct and RBC of the rabbits were increased significantly, (P＜0.01 ) but serum ALT, potassium and blood viscosity did not changed significantly. In rhEPO group, Hb, Hct increased significantly on the 14 days after applying rhEPO. Conclusion: It is effective and safe to treat postoperative anemia with a high dose of rhEPO in patients undergoing cardiac procedures. The administration of rhEPO corrects postoperative anemia quickly, then precludes many complications related to decrease oxygen delivery capacity.