氨甲环酸在全髋关节置换术围手术期疗效与安全性的meta分析  

A meta-analysis on efficacy and safety of tranexamic acid administration during total hip arthroplasty

作　　者：周磊[1] 李涛[1] 翁习生[1] 蒋超[1] 翟吉良[1] 彭慧明[1] 

机构地区：[1]中国医学科学院 北京协和医学院 北京协和医院骨科,北京100730

出　　处：《中国骨与关节外科》2013年第5期421-426,共6页Chinese Journal of Bone and Joint Surgery

基　　金：卫生行业科研专项经费资助项目(201002005)

摘　　要：背景:目前针对氨甲环酸(TXA)能否安全有效地降低全髋关节置换术(THA)的失血量和输血率尚未达成共识。目的:通过meta分析评价TXA在THA围手术期应用的有效性和安全性。方法:检索2003年至2013年PubMed、Medline、EMBase、Cochrane library、CNKI和万方数据知识服务平台中发表的有关TXA在THA中应用的相关临床随机对照研究,对TXA组与对照组术中失血量、术后失血量、总失血量、异体输血率及静脉血栓栓塞症(VTE)发生率进行meta分析。结果:筛选出符合纳入标准的高质量随机对照研究9篇,共460例(460髋)。与对照组比较,TXA可减少THA患者的术中失血量[WMD=-87.04,95%C(I-148.54,-25.55),P=0.006],术后失血量[WMD=-123.35,95%C(I-215.04,-31.66),P=0.008],总失血量[WMD=-247.74,95%C(I-350.60,-144.89),P<0.00001],降低输血率[OR=0.34,95%C(I0.21,0.55),P<0.0001],而VTE发生率无明显差异。结论:TXA可明显减少THA围手术期失血量,降低输血率,同时不增加发生VTE的风险。Background： Whether or not tranexamic acid （TXA） can effectively and safely reduce blood loss and allogeneic transfusion in total hip arthroplasty （THA） has not yet reached a consensus. Objective： To assess the efficacy and safety of TXA administration during THA through meta analysis. Methods： Clinical randomized controlled trials （RCTs） concerning TXA application in THA published from 2003 to 2013 were retrieved from the PubMed, Medline, EMBase, Cochrane library, CNKI and WanFang databases. A meta-analysis was conducted to evaluate intraoperative blood loss, postoperative blood loss, total blood loss, allogeneic transfusion and venous thromboembolism （VTE） in TXA-treated group versus control group. Results： Eventually 9 high-quality RCTs including 460 patients （460 hips） were chosen for the meta-analysis. Compared with control group, TXA significantly reduced intraoperative blood loss [WMD=- 87.04, 95% CI（-148.54,-25.55）, P=0.006], postoperative blood loss [WMD=- 123.35, 95%CI（-215.04, -31.66）, P=0.008], total blood loss [WMD=-247.74, 95%CI（- 350.60, -144.89）, P〈0.00001] and proportion of patients requiring allogeneic transfusion [OR=0.34, 95%CI（0.21, 0.55）, P〈 0.0001]. But there was no significant difference in the incidence of VTE between TXA-treated group and control group. Conclusions： TXA can significantly decrease perioperative blood loss and allogeneic transfusion during THA and will not raise the risk of VTE.

关 键 词：氨甲环酸 META分析 全髋关节置换术 失血 异体输血 

分 类 号：R687.4[医药卫生—骨科学]