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目的观察维持血液透析病人由规律口服铁剂改为应用静脉铁剂后EPO应用剂量、铁储备纠正及症状改善情况。方法选择维持血液透析病人(规律口服琥珀酸亚铁0.2mgTid治疗大于6个月)54例,停用口服铁剂予静脉铁剂(右旋糖酐铁)补铁治疗。静脉铁剂剂量根据患者每2个月Hb、SF、TSAT检测结果及时调整。比较治疗前及治疗后2、4、6个月患者Hb、SF、TSAT、EPO用量及肝肾功能动态变化、透析充分性、症状改善及不良反应情况。结果①治疗2个月后平均Hb上升5g/l,EPO用量减低15%,SF较前明显升高(P<0.05)。②转铁蛋白饱和度治疗6个月后有显著改善(P>0.05),EPO用量减低37%。肝肾功能治疗前后无显著差异(P>0.05)。③Kt/V无显著差异(P<0.05)。④贫血及消化道症状明显改善。⑤1例不良反应发生。结论规律应用静脉滴注右旋糖酐铁可以安全有效地减少长期血液透析病人rhEPO用量,改善铁储备及利用情况,提高患者生活质量。
Objective To observe the EPO dose, iron reserve correction and symptom improvement after hemodialysis patients switched from regular oral iron to intravenous iron. Methods 54 hemodialysis patients (regular oral administration of ferrous succinate 0.2 mg Tid for more than 6 months) were selected, and oral iron administration was stopped to iron supplementation with intravenous iron (dextran). Intravenous iron dose based on patients every 2 months Hb, SF, TSAT test results and timely adjustments. The levels of Hb, SF, TSAT, EPO, dynamic changes of liver and kidney function, dialysis adequacy, symptom improvement and adverse reactions were compared before treatment and 2, 4 and 6 months after treatment. Results ① After 2 months of treatment, the average Hb increased by 5g / l, the EPO dosage decreased by 15% and the SF increased significantly (P <0.05). Transferrin saturation after 6 months of treatment was significantly improved (P> 0.05), EPO decreased by 37%. Liver and kidney function before and after treatment was no significant difference (P> 0.05). ③Kt / V no significant difference (P <0.05). ④ anemia and gastrointestinal symptoms improved significantly. ⑤ 1 case of adverse reactions. Conclusion Regular application of iron dextran intravenously can safely and effectively reduce the dosage of rhEPO in long-term hemodialysis patients, improve the situation of iron reserves and utilization, and improve the quality of life of patients.