静脉铁剂的区别及注意事项

2019-06-27 高丽丽 医学之声

静脉铁剂主要有蔗糖铁(IS,蔗糖酸铁)、低分子右旋糖酐铁(ID)、羧基麦芽糖铁(FCM)、异麦芽糖酐铁、葡萄糖醛酸铁、纳米氧化铁、山梨醇铁等。临床可用于缺铁性贫血、肾性贫血、围手术期贫血等。

静脉铁剂主要有蔗糖铁(IS,蔗糖酸铁)、低分子右旋糖酐铁(ID)、羧基麦芽糖铁(FCM)、异麦芽糖酐铁、葡萄糖醛酸铁、纳米氧化铁、山梨醇铁等。临床可用于缺铁性贫血、肾性贫血、围手术期贫血等。

一.静脉铁剂的种类与区别

国内的静脉铁剂主要是蔗糖铁和右旋糖酐铁,两者改善贫血的疗效相似,但不良反应率有所不同。与右旋糖酐铁相比,蔗糖铁总体不良反应率、严重不良反应率、病死率均明显降低。考虑到安全性和药代动力学特点,推荐使用蔗糖铁。此外蔗糖铁可少量多次地输注。

有研究表明,右旋糖酐铁的不良反应主要与高分子质量右旋糖酐铁有关,推荐使用小分子质量右旋糖酐铁。低分子量右旋糖酐铁(LMW ID)可单次大剂量(总剂量)输注,也可分多次给予。高分子量右旋糖酐铁(HMW ID)发生严重反应的风险远远高于LMW ID,目前不推荐使用。因此若是选择只用输注1-2次的铁剂,可选低分子右旋糖酐铁或异麦芽糖酐铁。



二.静脉铁剂的注意事项

①静脉铁剂产生的羟基自由基能损伤肝脏,对肝功能不全者补充铁剂时要充分评估。若需静脉补充铁剂应密切监视铁的状态,避免铁过载,因铁过载是持续加重肝脏损伤的因素。此外肝硬化导致的上消化道大出血因肝功能较差应慎用静脉铁剂。

②慢性炎症性贫血合并铁缺乏时,因炎症因子使铁调素水平升高,会抑制肠道对口服铁剂的吸收,需使用静脉铁剂补铁。

③铁剂治疗促进氧自由基产生,可增加感染机会,同时尽管有争议,但仍不能排除静脉补铁有促进炎症和细菌生长的可能性,所以全身活动性感染时禁用,禁用于急慢性感染者。

④游离铁可致氧自由基产生,引起组织毒性,在使用注射铁剂前应检测血清铁蛋白水平,确诊铁缺乏。禁用于体内铁负荷过多者。另外铁过载者发生某些严重细菌感染的风险增加。

⑤补充静脉铁剂需防止铁过载,因可导致内脏含铁血黄素沉积。

⑥不能与口服铁剂同时使用。

⑦输注铁剂时有时会出现低血压,可能与输注过快、预防性使用抗组胺药如苯海拉明有关。

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    2019-11-02 fusion
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    2019-06-27 122e052cm96暂无昵称

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