Role Of Recombinant Human Erythropoietin In Critically Ill Patients

Purpose: In critical patients, the proceeding anemic is very common. The anemic reason is various, it includes: Repetitive puncture of vein in clinical examination procedures; blood losing from digestive tract; consumption anemia in the malnutrition; blood composition lowering in the inflammatory reaction; anemia resulting from chronic disease, etc. The anemic treatment usually needs to transfuse blood, following a very high expenses and the great risk. Recombinant human erythropoietin (rHuEPO) is widely used to treat the anemia resulting from chronic renal failure and the cancer. Our purpose is mainly to study the validity of the rHuEPO as an assistant treatment in the critical patients. We observe whether it can reduce blood transfusion and shorten ICU hospitalization time to economize the sufferer's total hospitalization expenses; Whether it can decrease the death rate and the complications to increase the survival quality of the patients.Methods: The prospective randomized control trial is used. In the ICU of west-China hospital, totally 57 patients are brought into the experiment anddivided into two groups (treatment group 30; control group 27) . Supplying the rHuEPO and the iron and vitamin B12 with the routine therapy treated the patients in the treatment group. Patients in the control group received the routine therapy. The patients brought into the trial received the grade point of APACHE Ⅱ in 24 hours. HB, Hct, RET, RBC; WBC. NEUT%; ALT, AST, DB, IB, TP, Alb; Urea, Crea were measured by collecting peripheral venous blood in the 1,7,10 and 14 days. The sufferer's life Physical signs were recorded everyday from the first day to fourteenth. Blood transfusion record was coincidence with the concrete usage. The blood transfusion, ICU stay time and the total hospitalization cost were compared between the two groups. We observed the variety change trend of every index. Statistical analysis: Differences between the two groups were explored by analysis of one-way analysis of variance (ANOVA) and followed up with two-sample t-test; an inside compare adopt the single factor square bad analysis, the death rate analysis adopt chi-square test and survival analysis. Results are expressed as mean ± sd.Results: (1) For the death rate in the twenty-one day, there are statistical significance difference in the two groups. The death rate of the treatment group was 13.3% and the control group was 37.0%,, the death rate of the treatment group was significant lower than the control group(0.025< P<0.05). For the survival analysis in the twenty-one day, the treatment group was highly than the control group. It was obvious on the survival rate curve. (D RET counts was presented statistical significance difference in the two groups. The treatment group presented an obviously increasing trend for theRET count. The average value continuous rose from 0.074 in the first day to the 0.123 in fourteenth. There are statistical significance difference in the treatment group. (PO.001) As the later three observation points compare with the first point, we found that there was no statistical significant difference between the seventh day and the first day (p>0.05) and among the tenth or fourteenth day and the first day there were statistical significance difference (pO.01) . RET count hadn't the obviously variety trend in the control group. The average value kept fundamentally stable from 0.085 in the first day to the 0.077 in fourteenth, there were no statistical significance difference in the control group. (P>0.05) ?Although there are no statistical significant difference the change of HB value presented an obviously trend in the two groups. The variance of HB value were no obvious on the four observation points in the treatment group. The average value kept fundamentally stable from 90.85 in the first day to the 89.04 at the fourteenth day (P>0.05). The range of descent of HB value was very low. In the control group, we found that the average value of HB continuous descent from 93.05 in the first day to the 83.1 in fourteenth day (P>0.05) and present obviously trend. ? blood transfusion was presented significant difference in the two groups. The amount of blood transfusion was 4200ml (n=30) and the average value was 140ml in the treatment group; The amount of blood transfusion was 16700ml (n=27) and the average value was 619ml in the control group. ? There were no significance difference on the total hospitalization cost in two groups. The average value of the treatment group was 33493 Yand the control group was 32293 Y; For the survived patients in the two groups, the average value of the total hospitalization cost was 28312 Y in the treatmentgroup and 44294Y in the control group, the reduction cost was 15981Y; In the subgroup of APACHE II score>20, the average of ICU hospitalization time and blood transfusions in the treatment group was obviously lower than the control group, the average total hospitalization cost could save 5950Y. ? The sufferer's life Physical signs (Bp HR CVP T) and the time of mechanical ventilation and hepatic function and renal function (ALT, AST, DB, IB, TP, Alb, Urea, Crea) had no statistical significance difference.Conclusion: The rHuEPO could increase the RET count, keep the HB value relative stable and decrease death rate; It could reduce blood transfusions and decrease ICU stay time and save the total hospitalization cost. From what we have been discussed we could draw a conclusion that the rHuEPO as an assistant treatment in the critical patients was beneficial to ICU patients.