抗纤维蛋白溶解药物应用于儿童心脏外科手术的系统评价与Meta分析  

Antifibrinolytic drugs used in pediatric cardiac surgery:a systematic review and Meta-analysis

作　　者：王前 梁星池 杨星海 刘俊 WANG Qian;LIANG Xingchi;YANG Xinghai;LIU Jun(Department of Surgery,Maternal and Child Health Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430070,China)

机构地区：[1]华中科技大学同济医学院附属湖北省妇幼保健院外科,武汉430070

出　　处：《中国药师》2024年第7期1257-1264,共8页China Pharmacist

基　　金：湖北省医学领军人才工程项目。

摘　　要：目的系统评估抗纤维蛋白溶解药物在儿童心肺转流的心脏手术中的止血功效的有效性及安全性。方法系统性检索PubMed、Embase和The Cochrane Library数据库,搜集所有采用抗纤维蛋白溶解药物在儿童心肺转流的心脏外科手术中应用的随机对照试验(RCT),检索时间从1980年1月1日至2023年10月14日。采用RevMan 5.4软件进行Meta分析。结果共纳入20篇研究23个RCT,其中涉及抑肽酶9篇,氨甲环酸10篇,氨基己酸4篇。Meta分析结果显示,与对照组相比,所有使用抗纤维蛋白溶解药物(抑肽酶、氨甲环酸、氨基己酸)的试验组可显著降低术后24 h的出血量、输血量(P<0.05);但两组血栓、死亡发生率差异无统计学意义(P>0.05)。结论抗纤维蛋白溶解药物在儿童心肺转流的心脏外科手术上具有止血作用。因相关的儿童研究证据较少,需进行大量的对比试验来评估这些药物相关的安全性以及适当的用药方案。Objective To systematically assess the efficacy and safety of antifibrinolytic drugs for hemostatic efficacy in cardiac surgery for cardiopulmonary diversion in children.Methods A systematic search of PubMed,Embase,and The Cochrane Library was performed to collect all randomized controlled trials(RCTs)using antifibrinolytic drugs in cardiac surgery for cardiopulmonary diversion in children from January 1st,1980 to October 14 th,2023.Meta-analysis was performed using RevMan 5.4 software.Results A total of 20 studies and 23 RCTs were included,with 9 involving peptidase,10 involving tranexamic acid,and 4 involving aminocaproic acid.The result of Meta-analysis showed that compared with the control group,all the experimental groups using antifibrinolytic drugs(peptidase,tranexamic acid,and aminocaproic acid)significantly reduced the amount of hemorrhage and transfusion in the first 24 h postoperatively(P<0.05);however,the difference of the incidence of thrombosis and death in the two groups was not statistically significant(P>0.05).Conclusion Antifibrinolytic drugs have hemostatic effects in cardiac surgery for cardiopulmonary bypass in children.Because of the paucity of evidence from relevant pediatric studies,a large number of comparative trials are needed to assess the safety associated with these drugs and the appropriate dosing regimen.

关 键 词：心脏手术 体外循环 抗纤维蛋白溶解药物 抑肽酶 氨甲环酸 氨基己酸 心肺转流 止血 安全性 

分 类 号：R726.5[医药卫生—儿科]