围手术期贫血是一种常见的合并症,与择期手术患者的发病率和死亡率风险增加有关。
■我们进行了系统的文献综述(SLR),以确定术前使用静脉注射羧基麦芽糖铁(FCM)治疗围手术期贫血的有效性和安全性,术中,和术后选择性手术护理。
■符合SLR纳入标准的研究报告了在围手术期期间随机分配到FCM治疗围手术期贫血的成人研究人群的治疗效果。筛选后,在MEDLINE和EMBASE数据库中搜索的181项研究中,有10项被纳入本综述。
■6项研究报告了术前治疗,一项研究中的术中治疗,两项研究的术后治疗,以及一项研究中的术前和术后治疗。一起,对1975名患者进行了研究,其中943人被随机分配到FCM,其中914人接受了FCM治疗。这10项研究报道了结肠直肠的择期手术人群,胃,骨科,腹部,泌尿外科,塑料,脖子,妇科,和耳鼻喉手术。鉴于研究的临床和方法学异质性,分析仅限于没有荟萃分析的定性评估.所有10项研究都报告了血红蛋白浓度统计学上更大的变化,血清铁蛋白,和/或FCM治疗的转铁蛋白饱和度与比较物(安慰剂,口服铁,标准护理,或这些的组合)。两项研究报告了输血率的统计学显着差异,两项研究报告了FCM与其比较者之间的住院时间显着差异。
■本SLR在现有数据的基础上增加了在术前和术后的FCM管理可改善血液学参数。该综述中的几项研究支持FCM在降低输血率和住院时间方面的有益作用。较大,精心设计,可能需要更长期的研究来进一步确定FCM在围手术期贫血择期手术患者中的疗效和安全性.
OBJECTIVE: Perioperative anemia is a common comorbid condition associated with increased risk of morbidity and mortality in patients undergoing elective surgical procedures.
OBJECTIVE: We conducted a systematic literature
review (SLR) to determine the efficacy and safety of the use of intravenous ferric carboxymaltose (FCM) for the treatment of perioperative anemia in preoperative, intraoperative, and postoperative elective surgical care.
METHODS: Studies meeting inclusion criteria for the SLR reported on treatment efficacy in an adult study population randomly allocated to FCM for the treatment of perioperative anemia during the perioperative period. After screening, 10 of 181 identified studies from searches in MEDLINE and EMBASE databases were identified for inclusion in this
review.
RESULTS: Preoperative treatment was reported in six studies, intraoperative treatment in one study, postoperative treatment in two studies, and both pre- and postoperative treatment in one study. Together, 1975 patients were studied, of whom 943 were randomized to FCM, of whom 914 received FCM treatment. The 10 studies reported elective surgical populations for colorectal, gastric, orthopedic, abdominal, urologic, plastic, neck, gynecologic, and otolaryngologic procedures. Given the clinical and methodological heterogeneity of the studies, the analyses were limited to qualitative assessments without meta-analyses. All 10 studies reported statistically greater changes in hemoglobin concentration, serum ferritin, and/or transferrin saturation with FCM treatment compared with comparators (placebo, oral iron, standard care, or a combination of these). Two studies reported statistically significant differences in transfusion rate and 2 studies reported significant differences in length of hospital stay between FCM and its comparator(s).
CONCLUSIONS: This SLR adds to existing data that administration of FCM in preoperative and postoperative settings improves hematologic parameters. Several studies in the
review supported the beneficial effects of FCM in reducing transfusion rate and length of stay. Larger, well-designed, longer-term studies may be needed to further establish the efficacy and safety of FCM in elective surgery patients with perioperative anemia.