Wang J, Ma H P, Zheng H
Department of Anaesthesiology, The First Affiliated Hospital of Xinjiang, Medical University, Urumqi, China.
Neth J Med. 2013 Apr;71(3):123-7.
The aim of this meta-analysis was to determine whether standard or titrated dosing of protamine is more effective in facilitating haemostasis after cardiac surgery with cardiopulmonary bypass (CPB).
We searched MEDLINE, and Biomedical Central using the terms 'cardiopulmonary bypass and heparin and protamine'. Studies were included in the meta-analysis if they were randomised controlled trials (RCTs), controlled clinical studies, or cohort studies with designs comparing the postoperative volume of bleeding between the study group (titrated dose) and the control group (standard dose) for protamine reversal of surgical anticoagulation in CPB procedures. The primary outcome of interest was postoperative blood loss.
There were 219 studies identified in the initial search; four of these were included in the meta-analysis. All studies were RCTs, involving a total of 507 patients. Postoperative blood loss was lower in the study group (range: 625-839 ml) compared with the control group (range: 765-995 ml) in all four studies. Transfusion of packed red blood cells was also lower in the study group compared with the control group in all four studies. There was no evidence of significant heterogeneity in postoperative blood loss among the four studies (Q=4.224, I2=28.98%, p=0.238); hence, a fixed-effects model of analysis was used. The overall/combined standardised difference in means of postoperative blood loss volume significantly favoured study treatment over control treatment (-0.562±0.322, p<0.001).
These findings suggest that titrated protamine dosing is more effective than standard protamine dosing for reducing postoperative bleeding after CPB.
本荟萃分析的目的是确定在体外循环（CPB）心脏手术后，标准剂量或滴定剂量的鱼精蛋白在促进止血方面是否更有效。
我们使用“体外循环、肝素和鱼精蛋白”等术语检索了MEDLINE和生物医学中心数据库。如果研究是随机对照试验（RCT）、对照临床研究或队列研究，且设计是比较研究组（滴定剂量）和对照组（标准剂量）在CPB手术中手术抗凝逆转时鱼精蛋白的术后出血量，则纳入荟萃分析。感兴趣的主要结局是术后失血量。
在初始检索中识别出219项研究；其中四项纳入荟萃分析。所有研究均为RCT，共涉及507例患者。在所有四项研究中，研究组的术后失血量（范围：625 - 839 ml）低于对照组（范围：76５ - 995 ml）。在所有四项研究中，研究组的浓缩红细胞输注量也低于对照组。四项研究之间术后失血量没有显著异质性的证据（Q = 4.224，I2 = 28.98%，p = 0.238）；因此，使用固定效应模型进行分析。术后失血量均值的总体/合并标准化差异显著有利于研究治疗而非对照治疗（-0.562±0.322，p < 0.001）。
这些发现表明，滴定剂量的鱼精蛋白在减少CPB术后出血方面比标准剂量的鱼精蛋白更有效。
