摘要
背景:目前临床上对在全膝关节置换过程中使用氨甲环酸结合引流管夹闭减少围置换期出血的有效性尚无定论。目的:系统评价在全膝关节置换过程中使用氨甲环酸结合引流管夹闭减少围术期出血的疗效。方法:计算机检索2008年1月至2018年6月PubMed、EMBASE、The Cochrane Library、中国知网(CNKI)、维普(VIP)和万方数据库(Wanfang Data),查找氨甲环酸结合引流管夹闭与其他疗法比较治疗全膝关节置换疗效的临床研究。由2位评价员依据纳入排除标准分别独立筛选文献、提取资料和评价纳入研究的方法学质量后,通过RevMan 5.3软件对治疗后各结局指标进行Meta分析,主要结局指标为输血人数,次要结局指标为总失血量、引流失血量、血红蛋白降低量和深静脉血栓形成人数。结果与结论:(1)最终纳入12个研究,共计1 220例患者;(2)Meta分析主要结局指标中,试验组输血人数显著少于对照组[RR=0.35,95%CI(0.23,0.52),Z=5.22,P <0.05];(3)Meta分析次要结局指标中,试验组总失血量显著低于对照组[MD=-325.45,95%CI(-445.12,-205.78),Z=5.33,P <0.05];试验组引流失血量显著低于对照组[MD=-269.85,95%CI(-334.78,-204.93),Z=8.15,P <0.05];试验组血红蛋白降低量显著低于对照组[MD=-0.91,95%CI(-1.23,-0.58),Z=5.46,P <0.05];试验组深静脉血栓形成人数少于对照组,但差异无显著性意义[RR=0.40,95%CI(0.08,2.05),Z=1.09,P> 0.05];(4)Meta分析结果表明,与对照组相比,氨甲环酸结合引流管夹闭能够显著减少全膝关节置换患者围手术期出血量。但由于纳入研究的数量和质量有限,未来仍需要更多高质量的随机对照试验来确定全膝关节置换患者给予氨甲环酸的最佳剂量和引流管夹闭的最佳持续时间。
BACKGROUND:Clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty still remain uncertain.OBJECTIVE:To systematically review the clinical effects of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty.METHODS:PubMed,EMBASE,The Cochrane Library,CNKI,VIP and WanFang databases were searched for the clinical trials addressing tranexamic acid plus drain-clamping versus other methods in total knee arthroplasty from January 2008 to June 2018.Two authors independently screened the literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality.The primary measurement outcome was the number of patients with blood transfusion.The secondary outcomes were total blood loss,drainage volume,decrease in hemoglobin,and the incidence of deep venous thrombosis.Changes in these outcomes were analyzed by a meta-analysis on RevMan 5.3 software.RESULTS AND CONCLUSION:(1)Twelve studies with 1 220 patients were included.(2)Meta-analysis results showed that the number of patients with blood transfusion in the trial group was significantly less than that in the control group[RR=0.35,95%CI(0.23,0.52),Z=5.22,P<0.05].(3)The total blood loss[MD=-325.45,95%CI(-445.12,-205.78),Z=5.33,P<0.05],drainage volume[MD=-269.85,95%CI(-334.78,-204.93),Z=8.15,P<0.05],and the decrease in hemoglobin[MD=-0.91,95%CI(-1.23,-0.58),Z=5.46,P<0.05]in the trial group were significantly lower than those in the control group.The incidence of deep venous thrombosis in the trial group was slightly lower than that in the control group[RR=0.40,95%CI(0.08,2.05),Z=1.09,P>0.05].(4)These results show that compared with the control group,tranexamic acid plus drain-clamping can significantly reduce perioperative blood loss in total knee arthroplasty.The number and the quality of the included studies are far from perfect,so more high-quality randomized controlled trials are needed to identify the optimal dose of tranexamic acid and the clamping hours.
作者
张岩
阚泉
张军伟
王宝华
平少华
Zhang Yan;Kan Quan;Zhang Junwei;Wang Baohua;Ping Shaohua(Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,Hebei Province,China;School of Basic Medicine,North China University of Science and Technology,Tangshan 063000,Hebei Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第4期643-649,共7页
Chinese Journal of Tissue Engineering Research
基金
河北省高等学校科学技术研究项目(QN2018123)~~
