局部应用氨甲环酸对全髋关节置换术术后出血有效性和安全性的Meta分析  

Efficacy and safety of local application of tranexamic acid for bleeding after primary total hip arthroplasty:a meta-analysis

作　　者：何峥峰[1] 颜廷卫[1] HE Zheng - feng YAN Ting -wei.(Orthopaedic Department, Laiwu Central Hospital of Xinwen Mineral Group, 271003, China)

机构地区：[1]新汶矿业集团莱芜中心医院骨科,271003

出　　处：《中国矫形外科杂志》2016年第19期1780-1786,共7页Orthopedic Journal of China

摘　　要：[目的]通过Meta分析评价局部应用氨甲环酸(tranexamic acid,TXA)对全髋关节置换术(total hiparthroplasty,THA)的有效性及安全性。[方法]计算机检索Cochrane Library、Medline、Embase、Pubmed英文数据库以及中国生物医学文献数据库、维普中国科技期刊数据库、万方数据库及中国知网数据库,根据纳入标准纳入所有关于局部应用TXA治疗THA术后出血的随机对照试验(RCTs),采用(Cochrane Handbook for Systematic Reviews of Interventions 4.2.5)中关于RCT的质量评价标准进行评估,使用Revman 5.3进行Meta分析。[结果]共纳入10篇文献,纳入患者1 112例,其中局部应用TXA 566例,对照组546例。局部应用TXA输血率为8.43%,对照组输血率为30.05%(P<0.001),局部应用TXA可以减少317.89 ml总失血量和76.82 ml隐形失血量,差异有统计学意义(P<0.001);局部应用TXA可以减少术中失血量,但差异无统计学意义(P=0.83),局部应用TXA后可以增加术后Hb数值,差异有统计学意义(P<0.001);局部应用TXA后DVT和PE发生率(3.03%)大于对照组(2.40%),差异无统计学意义(P=0.54),局部应用TXA术后感染发生率(3.03%)大于对照组(2.40%),差异无统计学意义(P=0.39)。[结论]局部应用TXA可以减少THA患者输血率和失血量而不增加其血栓形成的风险。[ Objective] To evaluate the efficacy and safety of local application of tranexamic acid （TXA） in primary total hip arthroplasty （THA） through a meta - analysis. [ Methods ] A computerized database search was done on Cochrane Library, Medline, Embase, PubMed, China Biology Medicine （CBM）, VIP China Science and Technology Journal Database, Wan- fang Data, and China National Knowledge Infrastructure （CNKI） for all randomized controlled trials （RCT） that evaluated the efficacy and safety of topical application of tranexamic acid versus normal saline during primary THA. The literature was tested u- sing the evaluation standard in the Cochrane Handbook for Systematic Reviews of Interventions 4. 2. 5 for the quality of their RCTs. Revman 5.3 was applied for the meta - analysis. [ Results ] A total of ten RCTs involving 1112 patients （566 in the topical TXA group and 546 in the control group） were identified. The transfusion rates of the topical TXA and control groups were 8.43% and 30. 05%, respectively, and the difference was statistically significant （P 〈 0. 000 01 ） . Compared with the control group, topical application of TXA significantly reduced total blood loss and hidden blood loss by 317. 89 ml and 76. 82 ml, re- spectively. Topical application of TXA also reduced blood loss during operation, but the difference between the two groups was not statistically significant （P = 0. 83） . In addition, topical application of TXA significantly increased the Hb value of patients when compared with the controls （P 〈 0. 000 01 ） . Meanwhile, the incidence rates of deep -venous thrombosis （DVT） and pulmonary embolism （PE） and the rate of infection were nonsignificantly higher in the TXA group than in the control group （3.03% vs 2. 40%, P =0. 54; 3.03% vs 2.40%, P =0. 39） . [ Conclusion] Topical application of TXA can reduce the need for transfusion and total blood loss in THA patients while not increasing their risk of DVT, PE, and infections.

关 键 词：氨甲环酸 局部应用 关节成形术 置换 髋 随机对照试验 

分 类 号：R687.4[医药卫生—骨科学]