关节置换术围手术期局部与静脉联合应用氨甲环酸减少失血量的系统评价：一项荟萃分析

A comparison of combined intravenous and topical administration of tranexamic acid with intravenous tranexamic acid alone for blood loss reduction after total hip arthroplasty: A meta-analysis.

机构信息

Department of Orthopaedics, the Eighty-Ninth Hospital of PLA, No. 256, North Palace West Street, Weifang City, Shandong province, 261021, China.

出版信息

Int J Surg. 2017 May;41:34-43. doi: 10.1016/j.ijsu.2017.03.031. Epub 2017 Mar 21.

DOI:10.1016/j.ijsu.2017.03.031

PMID:28336258

Abstract

BACKGROUND

The optimal dose and protocol of tranexamic acid (TXA) for reducing blood loss in total hip arthroplasty (THA) is controversial. Intravenous TXA (IV-TXA) and combined IV-TXA with topical TXA are the two common protocol after THA. A meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of combined IV and topical TXA with IV-TXA alone in reducing blood loss after THA.

METHODS

PubMed, Medline, Embase, Web of Science, the Cochrane Library, China Wanfang database and Google database were searched from the inception to February 2017 to identify RCTs that comparing combined IV and topical TXA with IV-TXA alone for patients prepared for primary THA. Total blood loss, hidden blood loss, transfusion rate, hemoglobin drop, length of hospital stay and the occurrence of deep venous thrombosis (DVT) were pooled to comprehensive analyses the efficacy and safety of combined IV and topical TXA with IV-TXA alone. Software Stata 12.0 was used to calculated relevant data.

RESULTS

Six RCTs involving 747 patients were finally included in the meta-analysis. Combined TXA decrease the volume of total blood loss and hidden blood loss by 250.37 ml (MD = -250.37; 95% CI: -376.43 to -124.31, P = 0.000) and 117.23 ml respectively (MD = -117.23; 95% CI: 228.38 to -6.07, P = 0.091). Meanwhile, combined TXA can also decrease the transfusion rate by 9.1% (RR = 0.32; 95% CI: 0.17 to 0.63; P = 0.001). No significant differences were seen in hemoglobin drop, the length of hospital stay and the occurrence of DVT between the two groups (P > 0.05).

CONCLUSIONS

Our meta-analysis suggests that the combined application of IV and topical TXA for patients undergoing THA may reduce the total blood loss compared with IV use alone without increasing the risk of postoperative complications. However, due to the quality and number of included studies, more studies were need to further identify the optimal dose for combine IV-TXA.

摘要

背景

氨甲环酸（TXA）在全髋关节置换术（THA）中减少失血的最佳剂量和方案仍存在争议。静脉注射 TXA（IV-TXA）和 IV-TXA 联合局部 TXA 是 THA 后的两种常见方案。本研究旨在通过荟萃分析比较 IV-TXA 与 IV-TXA 联合局部 TXA 用于初次 THA 的疗效和安全性。

方法

从建库至 2017 年 2 月，检索 PubMed、Medline、Embase、Web of Science、Cochrane 图书馆、中国万方数据库和 Google 数据库，以识别比较 IV-TXA 与 IV-TXA 联合局部 TXA 用于初次 THA 的随机对照试验（RCT）。汇总分析总失血量、隐性失血量、输血率、血红蛋白下降、住院时间和深静脉血栓形成（DVT）发生率，以综合分析 IV-TXA 联合局部 TXA 与 IV-TXA 单独应用的疗效和安全性。采用 Stata 12.0 软件计算相关数据。

结果

最终纳入 6 项 RCT，共 747 例患者。与 IV-TXA 相比，联合 TXA 可分别减少总失血量和隐性失血量 250.37ml（MD=-250.37；95%CI：-376.43 至-124.31，P=0.000）和 117.23ml（MD=-117.23；95%CI：228.38 至-6.07，P=0.091）。同时，联合 TXA 还可降低输血率 9.1%（RR=0.32；95%CI：0.17 至 0.63；P=0.001）。两组血红蛋白下降、住院时间和 DVT 发生率差异无统计学意义（P>0.05）。