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ВХОД ДЛЯ ПАЦИЕНТОВ вверх поиск админ главная
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из Некоторые доктора назначают при постравматической анемиии эритропоэтин (эпокрин). Это дорогой препарат, и обычно приобретается больным или родственниками. Показания к его назначению (Видаль): ============================== – анемия, вызванная дефицитом эритропоэтина у пациентов с хронической почечной недостаточностью – анемии, связанные с химио- и радиотерапией опухолей; – анемии, вызванные применением зидовудина у пациентов с ВИЧ-инфекцией; – эритропоэтин-зависимые анемии (в т.ч. при ревматоидном артрите и немиелоидных опухолях); – подготовка к обширным хирургическим вмешательствам (с целью уменьшения объемов переливаемой крови). ============================== Как же насчет анемий после травм? Поиск в Medline дал в результате скептические заключения в смежных ситуациях (см. ниже). Есть ли доказательные данные, что эпокрин обеспечивает значимый пооложительный эффект у больных с травмами? Применяется ли он для лечения бюольных с травмами в ваших условиях? Заранее спасибо. ========================== 1.A double-blinded prospective evaluation of recombinant human erythropoietin in acutely burned patients. Still JM Jr, Belcher K, Law EJ, Thompson W, Jordan M, Lewis M, Saffle J, Hunt J, Purdue GF, Waymack JP, et al. Augusta Regional Medical Center, Georgia. OBJECTIVE: To evaluate the effects of recombinant human erythropoietin (r-HuEPO) in attempting to prevent anemia in acutely burned patients. DESIGN: Prospective double-blind randomized study of 40 patients. METHODS: Patients with burns from 25% to 65% total body surface were enrolled. r-HuEPO or a placebo was begun within 72 hours of admission. Cell blood count, reticulocyte counts, transfusion requirements, and blood loss were measured. Comparison was carried out by the unpaired t test. MAIN RESULTS: There was no statistically significant difference in hemoglobin, hematocrit, reticulocyte count, ferritin, serum iron, total iron blinding capacity, or transfusion requirements. In patients with burns from 25% to 35%, the reticulocyte counts were statistically significantly higher. CONCLUSION: In our work the administration of r-HuEPO in acutely burned patients did not prevent the development of postburn anemia or decrease transfusion requirements. Increased erythropoiesis in smaller burns (25% to 35%) was observed and may indicate a reason for further study. 2.Acta Anaesthesiol Scand. 2003 Jul;47(6):687-92. Recombinant human erythropoietin in preoperative autologous blood donation did not influence the haemoglobin recovery after surgery. Avall A, Hyllner M, Bengtson JP, Carlsson L, Bengtsson A. Department of Anesthesia & Intensive Care, East Hospital, Goteborg, Sweden. anders.avall@vgregion.se BACKGROUND: Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment. METHODS: Thirty-eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery. RESULTS: No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL-1 in all but four patients. CONCLUSIONS: In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels. ==========================
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