血栓弹力图指导外科手术输血:系统评价和Meta分析  

Th romboelastography-guided Therapy Improves Patient Blood Management during Surgical Operation:A Systematic Review and Analysis

作　　者：杨功勋 高然 羊政 YANG Gong-xun;GAO Ran;YANG Zheng(Anhui Truimph Medical Science and Technology Co.,Ltd.246003)

机构地区：[1]安徽创孚医疗科技有限公司,安庆246003

出　　处：《临床输血与检验》2021年第3期319-323,共5页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：安徽省长三角科技创新联合攻关专项(No.202004g01020012)资助。

摘　　要：目的采用Meta分析对血栓弹力图指导的外科手术输血策略进行系统的评价。方法通过计算机检索1960年1月~2020年7月在PubMed、Web of Science、ScienceDirect等数据库所有公开发表的,国外有关TEG指导外科手术输血的随机对照试验(RCT),并通过手工检索相关论文。最终由2位评价员按照Cochrane手册进行文献质量评价后,应用RevMan 5.3软件对最终符合纳入标准的研究数据进行统计分析。共有8篇文献,包括863例患者,其中试验组366例,对照组497例。结果TEG指导外科手术围手术期输血与常规输血对红细胞输注率、术后死亡率的影响差异无统计学意义;与常规输血相比,TEG指导的输血策略可有效降低血小板输注率(P=0.02)、降低新鲜冷冻血浆的输注率(P<0.00001)、有效降低术后再次出血发生率(P=0.006)。结论外科手术过程中应用TEG指导输血能减少血小板和新鲜冷冻血浆的输注率,降低术后出血,是一种较为理想的输血指导方法。Objective Meta-analysis was used to systematically evaluate the blood transfusion strategies guided by Thromboelastography(TEG).Methods We searched computer-published randomized controlled trials(RCT)related to TEG-guided surgical blood transfusions published in PubMed,Web of Science,and ScienceDirect databases from January 1960 to July 2020,and we also manually searched for related papers.The quality of the included studies was assessed by two evaluation members according to the Cochrane collaboration network standard,and then the included studies were analyzed by RevMan 5.3 software.Results A total of 8 articles were included,involving a sample of 863 individuals,366 cases in the test group and 497 cases in the control group.The meta-analysis results showed that there were no significant difference between test group and control group in Red blood cell(RBC)infusion rate and postoperative mortality.Test group could significant reduce the frequency of Platelet transfusion(P=0.02),the frequency of Fresh frozen plasma(FFP)transfusion(P<0.00001),the frequency of bleeding after surgery(P=0.006).Conclusions The application of TEG to guide blood transfusion during surgical operation can reduce the transfusion rate of Platelet and FFP,meanwhile reduce postoperative bleeding.It is an ideal blood transfusion guidance method.

关 键 词：血栓弹力图 输血策略 META分析 

分 类 号：R457[医药卫生—治疗学]