氨甲环酸与抑肽酶对心脏手术血液保护的Meta分析  

Effects of tranexamic acid and aprotinin on blood - conservation in heart surgery： a meta - analysis

作　　者：叶博[1] 张国荣[1] 范勤[1] 曹晨[1] 魏国[1] 

机构地区：[1]中国人民解放军空军总医院麻醉科,北京100142

出　　处：《徐州医学院学报》2011年第4期215-218,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的 系统评价氨甲环酸与抑肽酶在体外循环心脏手术中的血液保护效果.方法 检索Medline、PubMed、中国期刊全文数据库、中国生物医学文献数据库中氨甲环酸与抑肽酶对CPB心脏手术患者血液保护的随机对照研究文献,收集各研究中的血小板、凝血指标、血红蛋白、血细胞比容、术中出血量、术后24 h纵隔心包引流量、输血例数、术后并发症及术后近期死亡例数.计数资料采用优势比和95%可信区间表示,计量资料采用加权平均值和95%可信区间（CI）表示,所有计算和统计用RevMan 4.2.10软件完成,异质性检验采用χ2和I2完成.结果 符合标准的文献共16篇,3 393例患者.分析显示,与抑肽酶相比,氨甲环酸术后24 h纵隔心包引流量偏多（WMD=-65.28 CI：-103.92,-26.65 P=0.0009）,但术后肾功能障碍患者例数明显较少（OR=1.36 CI：1.11,1.67 P=0.03）,而血小板计数、凝血指标、血红蛋白值、术中出血量、成分输血例数均无显著差异（P〉0.05）.结论 在体外循环心脏手术中,氨甲环酸的血液保护效果比抑肽酶稍差,但其安全性能高,不易引起肾功能损害.Objective To systematically evaluate the effect of tranexamic acid and aprotinin on blood conservation in open heart surgery with cardiopulmonary bypass. Methods A systematic overview and Meta - analysis were undertaken on all the randomized controlled trials of tranexamic acid and aprotinin in heart surgery from MEDLINE, PubMed, CNKI and CMB disk, with all the data as to platelets, coagulation indexes, hemoglobin （ Hb）, hematoerit （ Hct）, intraoperative hemorrhage volume, postoperative 24 h mediastinal pericardial drainage, cases of blood transfusion, postoperative complications and recent postoperative deaths. The weighted mean difference （WMD） with 95% confidence intervals （CI） for continuous data and odds ratio （OR） with 95% CI for dichotomous data were calculated. Statistical analysis was performed using RevMan 4.2.10. Heterogeneity was assessed using x2and I2 values. Results Sixteen trials was identified which included 3 393 patients. In comparison with aprotinin, tranexamie acid was associated with reduced renal dys-function（OR = 1.36 CI： 1. 11,1.67 P = 0. 03） , but was more in postoperrative bleeding （WMD = - 65.28 CI： -103.92, -26.65 P = 0. 0009 ） there were no significant differences in platelet counts, prothrombin time （PT） , activated partial thromboplastin time （APTT）, fibrinogen （Fib）, Hb, Hct, intraoperative hemorrhage volume and cases of transfusion of blood components between groups （ all P 〉 0.05 ）. Conclusion In open heart surgery with eardiopulmonary bypass, tranexamic acid seems to be less effective in blood conservation and superior in safety with less renal dysfunction compared with aprotinin.

关 键 词：氨甲环酸 抑肽酶 体外循环 血液保护 META分析 

分 类 号：R541[医药卫生—心血管疾病]