ε-氨基己酸可减少小儿心脏直视手术后的输血并改善凝血试验：5项临床试验的荟萃分析
Epsilon aminocaproic acid reduces blood transfusion and improves the coagulation test after pediatric open-heart surgery: a meta-analysis of 5 clinical trials.
作者信息
Lu Jun, Meng Haoyu, Meng Zhaoyi, Sun Ying, Pribis John P, Zhu Chunyan, Li Quan
机构信息
Department of Anesthesiology, Shanghai East Hospital, Tongji University School of Medicine Shanghai, China.
First Clinical Medical College of Nanjing Medical University Nanjing, China.
出版信息
Int J Clin Exp Pathol. 2015 Jul 1;8(7):7978-87. eCollection 2015.
BACKGROUND
Excessive postoperative blood loss after cardiopulmonary bypass is a common problem, especially in patients suffering from congenital heart diseases. The efficacy of epsilon aminocaproic acid (EACA) as a prophylactic treatment for postoperative bleeding after pediatric open-heart surgery has not been determined. This meta-analysis investigates the efficacy of EACA in the minimization of bleeding and blood transfusion and the maintenance of coagulation tests after pediatric open-heart surgery.
METHODS
A comprehensive literature search was performed to identify all randomized clinical trials on the subject. PubMed, Embase, the Cochrane Library, and the Chinese Medical Journal Network were screened. The primary outcome used for the analysis was postoperative blood loss. Secondary outcomes included postoperative blood transfusion, re-exploration rate and postoperative coagulation tests. The mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were used as summary statistics.
RESULTS
Five trials were included in this meta-analysis of 515 patients. Prophylactic EACA was associated with a reduction in postoperative blood loss, but this difference did not reach statistical significance (MD: -7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA received fewer postoperative blood transfusions, including packed red blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03). Prophylactic EACA also improved coagulation tests 6 hours after open-heart surgery.
CONCLUSIONS
Prophylactic EACA minimizes postoperative blood transfusion and helps maintain coagulation in pediatric patients undergoing open-heart surgery. Therefore, the results of this study indicate that adjunctive EACA is a good choice for the prevention of postoperative blood transfusion following pediatric cardiac surgery.
背景
体外循环术后失血过多是一个常见问题，尤其是在患有先天性心脏病的患者中。ε-氨基己酸（EACA）作为小儿心脏直视手术后预防出血的治疗方法的疗效尚未确定。本荟萃分析调查了EACA在减少小儿心脏直视手术后出血和输血以及维持凝血试验方面的疗效。
方法
进行了全面的文献检索，以确定所有关于该主题的随机临床试验。对PubMed、Embase、Cochrane图书馆和中国医学期刊网络进行了筛选。用于分析的主要结局是术后失血量。次要结局包括术后输血、再次手术率和术后凝血试验。使用95%置信区间（CI）的平均差（MD）和风险比（RR）作为汇总统计量。
结果
本荟萃分析纳入了5项试验，共515例患者。预防性使用EACA与术后失血量减少有关，但这种差异未达到统计学意义（MD：-7.08；95%CI：-16.11至1.95；P = 0.12）。接受EACA治疗的患者术后输血次数较少，包括浓缩红细胞（MD：-8.36；95%CI：-12.63至-4.09；P = 0.0001）、新鲜冰冻血浆（MD：-3.85；95%CI：-5.63至-2.08；P < 0.0001）和血小板浓缩物（MD：-10.66；95%CI：-18.45至-2.87；P = 0.007），且再次手术率较低（RR：0.46；95%CI：0.23至0.92；P = 0.03）。预防性使用EACA还改善了心脏直视手术后6小时的凝血试验。
结论
预防性使用EACA可减少小儿心脏直视手术患者的术后输血，并有助于维持凝血功能。因此，本研究结果表明，辅助使用EACA是预防小儿心脏手术后输血的良好选择。
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