不同麻醉方式对膝关节置换后下肢静脉血栓形成的影响:Meta分析（英文）  

Effects of general and epidural anesthesia on the formation of deep vein thrombosis after total knee arthroplasty: a meta-analysis

作　　者：艾克热木江.木合热木 黄筑忆 冯磊[1] 马显志[1,2] 刘庆[1] 

机构地区：[1]北京积水潭医院,北京市100035 [2]清华大学医学中心,北京市100084

出　　处：《中国组织工程研究》2015年第35期5735-5740,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:虽然全膝关节置换治疗严重膝关节炎患者疗效可靠,但是,下肢静脉血栓形成仍会在很多患者中发生,因此下肢静脉血栓形成也成了目前接受全膝关节置换后突然死亡的最主要原因。目的:比较不同麻醉方式下进行全膝关节置换后下肢静脉血栓形成的差异。方法:利用"total knee arthroplasty","TKA","thrombosis","DVT","randomized controlled trial","RCT","全膝关节置换""血栓""麻醉"等关键词在"Pub Med","Medline","Elsevier","Embase","Cochrane library","万方","CNKI"等国内外主要数据库搜集了2000年1月到2015年3月期间发表的涉及到不同麻醉方式对膝关节置换后下肢深静脉血栓形成的影响方面的文献资料。通过双盲法进行数据提取,文献质量评估,并利用Revman5.3统计软件对所提取的数据进行了meta分析。结果与结论:最后总共有包含885例患者的8个文献被纳入此研究。通过分析发现在纳入的文献之间不存在显著异质性(I2=0,P=0.72)。数据合成后的OR是0.25(95%CI:0.18,1.35),说明利用连续硬膜外麻醉方式进行全膝关节置换能显著降低术后深静脉血栓形成的可能。因为缺乏全身麻醉与硬膜外麻醉下的患者凝血因子变化情况等数据,硬膜外麻醉降低深静脉血栓发生率的机制尚需进一步研究。说明在接受下肢静脉血栓的患者中,利用连续硬膜外麻醉可显著降低下肢静脉血栓的形成可能。因此在下肢静脉血栓形成高危患者中应该优先使用硬膜外麻醉方式进行膝关节置换。BACKGROUND：Although the therapeutic effect of total knee arthroplasty for severe gonarthritis is reliable, deep vein thrombosis also occurred in many patients. Therefore, deep vein thrombosis has been a major reason for unexpected death after total knee arthroplasty. OBJECTIVE：To study the incidence of deep vein thrombosis after total knee arthroplasty with general and epidural anesthesia. METHODS：We searched“PubMed”,“Medline”,“Elsevier”,“Embase”, Cochrane library,“Wanfang”,“China National Knowledge Infrastructure”for papers published from January 2000 to March 2015. The mesh words were“total knee arthroplasty”,“TKA”,“thrombosis”,“DVT”,“randomized control ed trial”,“RCT”for studies concerning deep vein thrombosis after total knee arthroplasty with different anesthetic methods. The double blind method was used for data extraction and assessment of literature quality. Revman5.3 software was utilized to analyze the extracted data using meta-analysis. RESULTS AND CONCLUSION：There were 8 studies including 885 patients. The heterogeneity of the included studies was very low （I2=0, P=0.72）. The combined OR was 0.25 （95%confidence interval：0.18, 1.35）, indicating that continuous epidural anesthesia in total knee arthroplasty could apparently reduce the possible formation of postoperative deep vein thrombosis. Because of lack of the changes in coagulation factors under general anesthesia and epidural anesthesia, the mechanism underlying epidural anesthesia to reduce the incidence of deep vein thrombosis deserves further investigations. Among patients with deep vein thrombosis, continuous epidural anesthesia could diminish the possible formation of deep vein thrombosis. Thus, epidural anesthesia should be used firstly for knee replacement in patients with high risk of deep vein thrombosis.

关 键 词：植入物 人工假体 膝关节置换 下肢静脉血栓形成 全身麻醉 硬膜外麻醉 META分析 

分 类 号：R318[医药卫生—生物医学工程]