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局部应用与静脉注射氨甲环酸在初次全膝关节置换术中的有效性和安全性比较:一项随机对照试验的荟萃分析

Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials.

作者信息

Chen Tao-Ping, Chen Yu-Min, Jiao Jian-Bao, Wang Yun-Fei, Qian Li-Gang, Guo Zhao, Ma Zheng, Han Cui-Yu, Shi Tong-Huan

机构信息

Affiliated Hospital of Hebei University, Yuhua Dong Road, 212, Yuhua District, Baoding, Hebei Province, China.

Hebei University, Yuhua Dong Road, 342, Yuhua District, Baoding, Hebei Province, 071000, China.

出版信息

J Orthop Surg Res. 2017 Jan 19;12(1):11. doi: 10.1186/s13018-017-0512-4.

Abstract

BACKGROUND

This study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).

METHODS

PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.

RESULTS

Twelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI -68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI -40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI -337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.671.25, P = 0.58), hemoglobin (Hb) decline (MD -0.42, 95% CI -0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.552.50, P = 0.68).

CONCLUSIONS

Compared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.

摘要

背景

本研究旨在比较局部应用与静脉应用氨甲环酸(TXA)在初次全膝关节置换术(TKA)中减少失血的有效性和安全性。

方法

检索了PubMed、Embase、Cochrane图书馆、Web of Science、中国生物医学文献数据库(CBM)、万方数据库、中国知网以及谷歌学术,查找自起始至2015年9月期间比较局部应用与静脉应用TXA在TKA中减少失血情况的随机对照试验(RCT)。本系统评价和荟萃分析按照PRISMA标准进行。

结果

纳入了12项研究,报告了12项RCT,共1130例患者。与静脉应用TXA相比,局部应用TXA在总失血量(MD 2.08,95%CI -68.43至72.60,P = 0.95)、引流量(MD 18.49,95%CI -40.01至76.98,P = 0.54)、隐性失血量(MD 4.75,95%CI -337.94至347.44,P = 0.99)、输血需求(RR = 0.92,95%CI 0.671.25,P = 0.58)、血红蛋白(Hb)下降(MD -0.42,95%CI -0.89至0.05,P = 0.08)以及深静脉血栓形成(DVT)发生率(RR = 1.17,95%CI 0.552.50,P = 0.68)方面均无显著差异。

结论

与静脉应用TXA相比,局部应用TXA在TKA中减少失血方面具有相当的有效性和安全性。由于纳入研究质量较差,需要更多高质量的RCT来确定TKA后TXA的最佳应用方法和剂量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ea51/5244538/6c835662339b/13018_2017_512_Fig1_HTML.jpg

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