摘要
[目的]探讨静脉与局部应用氨甲环酸(tranexamic acid,TXA)在初次单侧全膝关节置换术(TKA)中应用的安全性和有效性。[方法]通过计算机检索Pub Med、Cochrane Library、Embase、CNKI、CBM、万方数据库有关TKA术中应用TXA行关节腔注射的随机对照试验(RCT)和半随机对照试验(qRCT),同时手工检索图书馆馆藏期刊。依照纳入标准对文献进行筛选、提取资料后,使用Cochrane系统评价方法评价纳入文献的质量,采用Rev Man5.2对资料进行Meta分析。[结果]共纳入9篇文献,合计1 422例。Meta分析结果显示:1有效性:静脉组与局部组对比,术后总失血量[SMD=0.14,95%CI(-0.28,0.57),P=0.51]、TKA术后血红蛋白(Hb)的丢失量[SMD=-0.29,95%CI(-0.91,0.33),P=0.36]、术后输血率[RR=1.06,95%CI(0.72,1.58),P=0.76]以及术后引流量[SMD=0.31,95%CI(-0.36,0.98),P=0.37];2安全性:静脉组与关节组对比,术后发生深静脉血栓(DVT)的风险[RR=0.64,95%CI(0.28,1.46),P=0.29]。[结论]本研究结果表明,行初次单侧全膝关节置换术静脉与关节腔局部使用氨甲环酸对血红蛋白(Hb)丢失量、输血率、引流量、总失血量以及DVT发生率方面差异均无统计学意义,所以关节腔局部注射氨甲环酸有着和静脉应用氨甲环酸同样的临床应用价值。
[Objective] To systematically evaluate the efficacy and safety of topical versus intravenous tranexamic acid during primary unilateral total knee arthroplasty. [Methods] We electronically searched Pub Med,Cochrane Library,EMBASE,CNKI,CBM and Wanfang Data from inception to July 2015 and manually searched journal of library collection to identify randomized controlled trial（ RCT） and Quasi- randomized controlled trial（ qRCT） about intra- articular versus intravenous injection of tranexamic acid in patients undergoing primary unilateral TKA. The methodological quality of the included trials was assessed and the data were extracted according to the Cochrane Handbook 5. 1. 0. Meta- analysis. Data were analyzed using RevMan 5. 2 software. [Results] A total of nine articles involving 1 422 patients were included. Compared with the results in topical group,the efficacy in the intravenous group was as follows. The postoperative total blood loss was [SMD = 0. 14,95% CI（- 0. 28,0. 57）,P = 0. 51],the; hemoglobin loss was [SMD =- 0. 29,95% CI（- 0. 91,0. 33）,P = 0. 36],the transfusion rate was [RR = 1. 06,95% CI（ 0. 72,1. 58）,P = 0. 76] and the drained blood loss was [SMD = 0. 31,95% CI（- 0. 36,0. 98）,P = 0. 37]. Compared with the results in topical group,the incidence of deep vein thrombosis in the intravenous group was [RR = 0. 64,95% CI（ 0. 28,1. 46）,P = 0. 29]. [Conclusion] No difference has been found in the postoperative total blood loss,hemoglobin loss,transfusion rate,drained blood loss between topical and intravenous ranexamic acid during primary unilateral total knee arthroplasty. So,intra- articular tranexamic acid injection has the same clinical application value to intravenous.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第9期806-810,共5页
Orthopedic Journal of China
基金
江苏省临床医学科技专项资助项目(编号:BL2012002)
