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1、临床医学论文•静脉与口服铁剂对肾性贫血的临床观察作者:张吉胜包蓿艳尤晓青刘婷刘苑萍吕敏【摘要】观察慢性肾功能不全患者静脉和口服补铁治疗肾性贫血的疗效、不良反应的发生情况以及对促红细胞生成素(EPO)使用效应的比较。〔方法〕将我院2006.11-2007.10期间病情稳定的48例肾性贫血患者随机的分为静脉组和口服组2组,每组24例,观察期10周。所有患者均常规使用EPO治疗,剂量为100U/kg・w,皮下注射,若患者血红蛋白(Hb)达10g/dl则将EPO剂量减少50%,若患者HB达12g/dl则将EPO剂量减少75%。观察用
2、药前、用药后4周、用药后8周、用药后10周的Hb、红细胞压积(Het)、铁蛋白(SF)、不良反应以及应用EPO剂量。〔结果〕治疗后两组患者的Hb、Hcl、SF均较治疗前有明显升高,而静脉组升高幅度显著于口服组(P<0.01),两组患者应用EPO的剂量在治疗后较治疗前均有所减少,而静脉组减少明显(PV0.05),静脉组不良反应的发生率明显低于口服组,EPO的效应明显高于口服组。〔结论〕静脉补铁不仅能及时有效地补充肾性贫血患者所需的铁剂,使贫血状况改善,不良反应少,可安全应用,而且能增强EPO效应,减少其用量。【关键词】肾性贫血
3、右旋糖酸氢氧化铁琥珀酸亚铁促红细胞生成素Abstract:〔Objective〕Tocomparethetherapeuticeffectsandadversereactionsbetweenintravenousandoraliron,andtheeffectsoferythropoietin(EPO)inpatientswithchronicrenalfailure.[Methods]BetweenNovember,2006andOctober,2007,48patientswithrenalanemiawererand
4、omizedinto2groups:intravenousgroupandoralgroup,24ineach.Thedurationofadministrationlastedfor10weeks.AllpatientsreceivedregularEP0,withthedoseoflOOU/kg/week.Ifthepatient,shemoglobin(Hb)wasmorethanlOg/dl,thenthedoseofEPOdecreasedby50%.Ifthepaticnt,sHbwasmorethan12g/d
5、l,thenthedosedecreasedby75%.ThelevelsofHb,hematocrit,serumferritin,adversereactionanddoseofEPObeforeand4weeks,8weeksand10weeksaftertheadministrationwereobserved.(Results]ThelevelsofHb,HctandSFinbothgroupsafteradministrationincreasedcomparedwithbeforeadministration;
6、andtherewassignificantdifferencebetweentheintravenousgroupandtheoralgroup(PvO.Ol).ThedosagesofEPOinbothgroupsafteradministrationwere1owerthanbeforeadministration,whereasthedosageintheintravenousgroupdecreasedsignificantly(P<0・05).Intheintravenousgroup,theadverserea
7、ctionsweresignificantly1owerandtheeffectofEPOwassignificantlyhigherthanintheoralgroup.〔Conclusions〕Theintravenousironcannotonlysupplytheirontothepatientswithrenalanemia,butalsoincreasetheeffectofEPOandreducethedosageofEPO.Theadversereactionsofintravenousironarelowa
8、nditissafeandconvenient.Keywords:renalanemia;intravenousiron;erythropoietin肾性贫血是慢性肾功能衰竭的重要并发症,促红素是治疗肾性贫血的首选用药。但是诸多因素影响了其疗效,其中最常见原因是铁缺乏〔1〕,目前静脉铁剂在