血栓弹力图仪指导肝移植围手术期输血的Meta分析  

Application of thromboelast ography in perioperative orthotopic liver transplantation:a meta-analysis

作　　者：卫志燕[1] 许大巍[1] 

机构地区：[1]山西省人民医院,030012

出　　处：《实用医技杂志》2016年第5期469-471,共3页Journal of Practical Medical Techniques

摘　　要：目的采用Meta分析评价应用血栓弹力图仪(TEG)指导肝移植围手术期输血的有效性及安全性。方法检索Cochrane图书馆、Pub Med、EMbase、Web of Science、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)及万方数据库,并辅以文献追溯的方法,收集肝移植围术期应用血栓弹力图仪(TEG)指导临床合理输血的临床随机对照试验(RCT)。按Cochrane系统评价方法,评价所纳入文献的质量,并采用Rev Man 4.2软件进行Meta分析。结果共有4条文献纳入研究,共计244例患者。TEG指导输血与常规输血对肝移植患者3年存活率的影响差异无统计学意义。TEG指导的肝移植手术与非TEG指导的肝移植手术围手术期出血量差异有统计学意义。TEG高参数检测结果指导输血与一般参数检测指导输血在肝移植围手术期出血量、浓缩红细胞使用量、血浆使用量研究中差异无统计学意义;血小板冷沉淀差异有统计学意义。TEG指导输血围术期浓缩红细胞使用量明显降低[MD=-0.59,95%CI(-7.60,-2.59),P<0.01]。TEG指导输血围术期血浆使用量明显降低[MD=-9.85,95%CI(-13.66,-6.03),P<0.01]。结论肝移植围术期应用TEG指导输血能减少血液制品的使用量,是较为理想的输血指导方法。Objective To systematically assess the applicability and safety of Thromboelastography（TEG）guided transfusion in perioperative orthotopic liver transplantation. Methods We searched Cochrane library,Pub Med,EMbase,Web of Science,CBM,CNKI,VP and Wanfang Data. Randomized controlled trials（RCTs） were identified about TEG monitoring in perioperative orthotopic liver transplantation. Study selection and meta-analysis were conducted according to the Cochrane Handbook for systematic reviews. Data were analyzed by Rev Man 4.2 software. Results Four trials involving244 patients were included. There was no significant difference between TEG group and Standard group in 3 years survival rate. TEG could reduce the amount of perioperative bleeding volume,the amount of RBC[MD =-0.59,95% CI（-7.60,-2.59）,P〈0.01]and FPor FFP [MD =-0.59,95% CI（-7.60,-2.59）,P〈0.01]. There was no significant difference between higher TEG group and TEG group in the amount of bleeding volume,the amount of RBC,FP or FFP;there was significant difference between higher TEG group and TEG group in the amount of Platelet and cryoprecipitate. Conclusion Application of TEG in perioperative orthotopic liver transplantation can reduce the amount of blood transfusion. TEG is an ideal transfusion guidance method.

关 键 词：肝移植 血栓弹力描记术 输血 META分析 

分 类 号：R657.3[医药卫生—外科学] R457.1[医药卫生—临床医学]