摘要
目的采用Meta分析评价局部应用氨甲环酸(TXA)对全膝关节置换(TKA)术后失血量的影响。方法计算机检索Corhrane图书馆、Medline、Embase、中国生物医学文献数据库、维普数据库中关于局部应用TXA减少TKA术后出血量的随机对照研究(RCT)。采用RevMan 5.0.24软件进行统计分析,TXA组与对照组总失血量、引流量、血红蛋白下降值、D-二聚体和术后KSS功能评分采用加权均数差评价,输血率采用优势比评价。结果最终共纳入8篇RCT。Meta分析结果显示,与对照组比较,局部应用TXA能够减少TKA术后总出血量[WMD=-302.05,95%CI(-345.05,-259.05),P<0.001]及引流量[WMD=-253.70,95%CI(-293.75,-213.65),P<0.001],血红蛋白下降较少[WMD=-0.64,95%CI(-0.85,-0.43),P<0.001],降低输血率[OR=0.29,95%CI(0.17,0.48),P<0.001]。结论局部应用TXA可以减少TKA术后失血量及引流量,降低输血率。
Objective To assess the effectiveness and safety of local application of Tranexamic acid （TXA） in reducing blood loss in total knee arthroplasty （TKA）. Methods Studies were identified by computer from the Cochrane Central Register of Controlled Trials （Central, 2013, Issue 3）, MEDLINE （Jan. 1966 to Oct. 2013）, EMBASE （Jan. 1966 to Oct. 2013）, CBM（Jan. 1978 to Oct. 2013） and VIP（Jan. 1978 to Oct. 2013）, relevant journals or conference proceedings were also searched manually. Weighted mean difference （WMD） of blood loss, drain, decreased hemoglobin values, D-dimmer and postoperative KSS function score, odds ratio （OR） of transfusion in topical TXA-treated group versus placebo group were calculated across studies. Results Eight RCIs met the criteria for metes-analysis. The use of topical TXA significantly reduced total blood loss [WMD=-302.05, 95%CI（-345.05, -259.05）, P 〈0.001], and drainage[WMD=-253.70, 95%CI（-293.75, -213.65）, P 〈0.001], hemoglobin was less reduced[WMD=-0.64, 95%C1（-0.85, -0.43）, P 〈0.001], reduced transfusion rate[OR=0.29, 95%CI（0.17, 0.48）, P 〈0.001], without rising the risk of D-dimmer and changing KSS account postoperative 3 months and half a year compared with placebo group. Conclusion This meta-analysis indicates that the use of topical TXA for patients undergoing TKA is effective and safe in reducing total blond lass and the requirement of blood transfusion.
出处
《中国骨与关节损伤杂志》
2014年第8期772-775,共4页
Chinese Journal of Bone and Joint Injury
基金
国家自然科学基金(81372013)
