接受大手术的非贫血患者术前补铁：一项系统回顾和荟萃分析

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-04-04 DOI:10.1016/j.bjane.2025.844618

Fabio Vieira Toledo, Daniel De Carli, Jose Fernando Amaral Meletti, Herman Yuri Almeida Togo, Italo Pires Gomes, Renato Makoto Sakashita, Lucas Felix Montes, Rafael Santos Tiburcio, Cesar de Araujo Miranda

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引用次数: 0

摘要

背景：输血与发病率和死亡率增加有关，维持全球血液供应可能是一项挑战。本系统综述调查术前补铁对大手术非贫血患者输血风险的影响。方法：我们对PubMed、Embase和Cochrane Central进行了系统检索，检索截至2024年5月发表的随机对照试验。包括使用促红细胞生成素的研究，或在试验随机化时已经使用铁补充剂的患者被排除在外。评估的结果包括接受输血的人数，以及第一天和术后第一周的平均血红蛋白水平。结果：9项研究共纳入1162名非贫血患者。其中54%的患者术前补铁。平均年龄为71岁，其中44%为女性。术前补铁与输血风险显著降低相关(OR = 0.54；95% CI 0.40 ~ 0.75；P < 0.001)。术后第一天，补铁组的平均血红蛋白水平明显高于未治疗组(MD = 0.22 g.dL-1；95% CI 0.02 ~ 0.42； = 0.03页)。然而，合并结果不能排除第一周平均血红蛋白水平差异的零假设(MD = 0.12 g.dL-1；95% CI -0.12 ~ 0.35； = 0.34页)。结论：在接受大手术，特别是心脏手术的非贫血患者术前静脉补铁可显著减少输血需求。然而，口服铁的益处仍然不确定，需要进一步的研究来建立标准化的围手术期补充方案。普洛斯彼罗标识符：CRD42024552559。

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Preoperative iron supplementation in non-anemic patients undergoing major surgery: a systematic review and meta-analysis

Background

Blood transfusions are associated with increased morbidity and mortality, and maintaining global blood supplies can be a challenge. This systematic review investigates the impact of preoperative iron supplementation on the risk of blood transfusion among non-anemic patients undergoing major surgeries.

Methods

We conducted a systematic search of PubMed, Embase, and Cochrane Central for randomized controlled trials published up to May 2024. Studies involving the use of erythropoietin, or patients already using iron supplementation when trial randomization was conducted were excluded. Outcomes assessed included the number of individuals who received blood transfusions, and mean hemoglobin levels at the first day and by the first postoperative week.

Results

A total of 1,162 non-anemic patients from 9 studies were included. Of these, 54% received preoperative iron supplementation. The average age was 71 years, and 44% were women. Preoperative iron supplementation was associated with a significantly lower risk of receiving a blood transfusion (OR = 0.54; 95% CI 0.40 to 0.75; p < 0.001). At the first postoperative day, the iron supplementation group had significantly higher mean hemoglobin levels compared to the no-treatment group (MD = 0.22 g.dL^-1; 95% CI 0.02 to 0.42; p = 0.03). However, the pooled results could not rule out the null hypothesis for the difference in mean hemoglobin levels throughout the first week (MD = 0.12 g.dL^-1; 95% CI -0.12 to 0.35; p = 0.34).

Conclusion

Preoperative intravenous iron supplementation in non-anemic patients undergoing major surgeries, particularly cardiac procedures, significantly reduces transfusion requirements. However, the benefits of oral iron remain uncertain, and further research is warranted to establish standardized perioperative supplementation protocols.