术前单用静脉铁剂对胃肠肿瘤相关性贫血的治疗作用

基础医学与临床 ›› 2012, Vol. 32 ›› Issue (6): 669-672.

术前单用静脉铁剂对胃肠肿瘤相关性贫血的治疗作用

马志强¹,葛军娜²,于健春³,康维明⁴,叶欣⁴

1. 中国医学科学院北京协和医学院北京协和医院
2. 北京协和医院基本外科
3. 中国医学科学院北京协和医学院北京协和医院普通外科
4. 北京协和医院

收稿日期:2012-04-06 修回日期:2012-04-25 出版日期:2012-06-05 发布日期:2012-05-25
通讯作者: 马志强 E-mail:mazhqng@yahoo.com.cn

The effectiveness of preoperative intravenous iron alone for patients of gastrointestinal tumor with anemia

Received:2012-04-06 Revised:2012-04-25 Online:2012-06-05 Published:2012-05-25

摘要/Abstract

摘要： 目的评估术前单用静脉铁剂对升高胃肠肿瘤合并贫血患者的治疗作用。方法收集2010年6月-2012年2月北京协和医院基本外科住院并接受手术治疗的胃肠肿瘤合并术前贫血的患者，对贫血合并缺铁的患者给予静脉铁剂治疗，在手术当日晨起或铁剂治疗后第14天晨起复查血常规、血清铁、铁蛋白水平、转铁蛋白、肝肾功能的检查，记录围手术期患者接受输血剂量，与同期住院合并贫血患者的围手术期输血量进行比较。结果共有121例患者入组。术前静脉铁剂的应用能迅速的提高血色素水平，升高红细胞数量，改善红细胞的MCV、MCHC和MCH指标。静脉铁剂治疗后短期内血清铁以及血清铁蛋白水平显著升高（P<0.05），与治疗前相比均有统计学差异。与治疗前血色素水平<100g/L相比，治疗前血色素水平≥100g/L的患者对静脉铁剂的反应较差。铁剂治疗组与同期未行铁剂治疗的胃肠肿瘤并贫血患者围手术期平均输血量差别比较明显（P<0.05）结论在胃肠肿瘤合并贫血患者中，单用静脉铁剂能安全、快速提高患者的血色素水平以及机体缺铁状态，并降低贫血患者围手术期输血量。静脉铁剂的疗效可能受贫血程度影响。

关键词: 消化道恶性肿瘤, 肿瘤相关性贫血, 缺铁性贫血, 静脉铁剂

Abstract: Objectives: To evaluate the effectiveness and security of preoperative intravenous iron alone in patients of gastrointestinal tumor with anemia and find out the validity to reduce the perioperative blood transfusion. Methods: to collect the information of patients with preoperative anemia admitted to Beijing Union Medical College Hospital From June, 2010 to February, 2012 for gastrointestinal tumor. Patients with iron deficiency anemia were administrated of intravenous iron by the way of intravenous drip. In the morning of operation or 14th day after treatment, we review the blood routine, serum iron, ferritin, transferrin protein, liver and kidney function tests. Perioperative blood transfusion dose of those subjects was compared with that of the same period of hospitalization in patients with anemia. Results: A total of 121 patients entered and completed the study, in which 13 cases of gastrointestinal stromal tumor, 59 cases of gastric cancer and 49 cases of colorectal cancer. Application of preoperative intravenous iron improved hemoglobin level rapidly, and also increased red blood cell count. MCV, MCHC and MCH which are indicators of red blood cell were improved after treatment. Shortly after intravenous iron treatment, serum iron and serum ferritin levels were significantly increased compared with that before treatment（P<0.05）. And the patients with a hemoglobin levels before treatment <100g/L had a better response to intravenous iron compared to which with pre-treatment hemoglobin level ≥ 100g/L. Iron treatment can reduce the perioperative transfusion of red blood cell dose compared with the non treatment anemia patients with cancer（P<0.05）. Conclusion: In the gastrointestinal cancer patients with pre-treatment anemia, intravenous iron alone can increase the hemoglobin, decrease the iron deficiency of preoperative anemia patients safely and rapidly, and can reduce perioperative blood transfusion. The efficacy of intravenous iron may be affected by the degree of anemia.

Key words: gastrointestinal tumors, cancer-related anemia, iron deficiency anemia, intravenous iron

马志强葛军娜于健春康维明叶欣. 术前单用静脉铁剂对胃肠肿瘤相关性贫血的治疗作用[J]. 基础医学与临床, 2012, 32(6): 669-672.