氨甲环酸在非体外循环冠脉移植手术中应用效果与安全性的系统评价  

The efficacy and safety of tranexamic acid in patients undergoing off-pump coronary bypass grafting:a systematic review and meta-analysis

作　　者：娄小飞[1] 阚全程[1] 杜书章[1] 付俊涛[1] 

机构地区：[1]郑州大学第一附属医院药学部,郑州450052

出　　处：《重庆医学》2015年第9期1232-1234,1238,共4页Chongqing medicine

基　　金：河南省医学科技攻关计划项目(201303018)

摘　　要：目的系统评价氨甲环酸(TA)在非体外循环冠状动脉移植手术中使用的有效性与安全性。方法计算机检索MEDLINE、Embase等数据库,收集TA用于非体外循环冠状动脉移植术的随机对照临床试验(RCT),使用Cochrane协作网的RevMan 5.2软件对纳入文献进行系统评价。结果共纳入10个RCT,共851例患者。TA可显著减少术后总出血量(24h:SD=-208.41,95%CI:-311.48^-105.35,P<0.000 1),降低围术期同种异体输血风险(RR=0.47,95%CI:0.33~0.66,P<0.000 1),可显著降低输入袋装红细胞的人数(RR=0.60,95%CI:0.49~0.74,P<0.001)。该研究尚无足够证据证明TA与血栓栓塞事件有关。结论 TA可减少OPCAB手术患者的出血量和输血风险。由于样本量小、剂量小、随访时间短的问题,其不良反应仍存争议,仍需更多高质量的临床试验进行确证。Objective The aim of this study is to evaluate the efficacy and safety of tranexamic acid for patients undergoing off-pump coronary bypass grafting .Methods The MEDLINE ,Embase were searched for randomized controlled trials（RCTs） of patients undergoing off-pump coronary bypass grafting .And the Cochrane Collaboration′s RevMan 5 .2 software was used to evalu-ate the quality of the included studies and to perform the meta-analyses .Results 10 trials involving 851 patients were included . Tranexamic acid significantly reduced the postoperative blood loss （24 h：SD= -208 .41 ,95% CI：-311 .48 - -105 .35 ,P〈0 .000 1） ,overall risk of allogeneic blood component transfusion（RR=0 .47 ,95% CI：0 .33 -0 .66 ,P〈 0 .000 1） ,and packed red blood cell transfusions（RR=0 .60 ,95% CI：0 .49-0 .74 ,P〈0 .001） .But no association was found between tranexamic acid and ad-verse thrombotic events .Conclusion Tranexamic acid significantly reduced the postoperative blood loss and overall risk of allogene-ic in patients undergoing OPCAB .However ,due to the limited quality of the included studies ,further evidence with more high quali-ty studies is still needed .

关 键 词：氨甲环酸 非体外循环 冠状动脉移植术 冠状动脉搭桥术 meta分析 

分 类 号：R654.2[医药卫生—外科学]