静脉注射氨甲环酸用于髋部骨折手术止血的有效性和安全性：一项荟萃分析。
Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: A meta-analysis.
作者信息
Zhang Pei, He Jinshan, Fang Yongchao, Chen Pengtao, Liang Yuan, Wang Jingcheng
机构信息
Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China Dalian Medical University, Dalian, Liaoning, China.
出版信息
Medicine (Baltimore). 2017 May;96(21):e6940. doi: 10.1097/MD.0000000000006940.
BACKGROUND
Patients undergoing hip fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease blood loss and transfusion rates in joint replacement surgery. Therefore, we conducted a meta-analysis to evaluate efficacy and safety of intravenous TXA administration in patients suffering from hip fractures.
METHODS
Electronic databases were searched before December 2016 by 2 independent reviewers, including Cochrane Library, EMBASE, PubMed, Web of Science, the Chinese Biomedical Literature database, and the China National Knowledge Infrastructure databases. Randomized controlled trials (RCTs) involving the efficacy and safety of intravenous (IV) TXA in patients who underwent hip surgery were included in our meta-analysis. The endpoints included total blood loss, hidden blood loss, postoperative hemoglobin decline, transfusion rates, the rate of thrombotic events, and operative time. Current meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out using STATA V.12.0 software.
RESULT
Eight RCTs were included, involving 598 participants. Current meta-analysis indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = -277, 95%CI: -335 to -220, P = .000), less hidden blood loss (WMD = -246, 95%CI: -252 to -241, P = .000), lower postoperative hemoglobin decline (WMD = -1.36, 95% CI: -1.84 to -0.88, P = .000), and lower transfusion rates (risk difference [RD] = -0.19, 95% CI: -0.27 to -0.11, P = .000) compared to the control group. No significant differences were found regarding the rate of thrombotic events (RD = 0.02, 95% CI: = -0.01 to 0.05, P = .262) and operative time (WMD = -0.7, 95% CI: -3.3 to 1.9, P = .6).
CONCLUSION
It was well established that systemic administration of TXA could reduce blood loss and transfusion rates in hip fracture surgery. But the optimal regimen, dosage, and timing still need a further research. In addition, more large and high-quality randomized controlled studies are needed to focus on the safety of IV TXA application before its wide recommendation for use in hip fracture surgery.
背景
接受髋部骨折手术的患者经常需要输血。氨甲环酸（TXA）已广泛用于减少关节置换手术中的失血和输血率。因此，我们进行了一项荟萃分析，以评估静脉注射TXA对髋部骨折患者的疗效和安全性。
方法
2016年12月之前，由2名独立审阅者检索电子数据库，包括Cochrane图书馆、EMBASE、PubMed、科学网、中国生物医学文献数据库和中国知网数据库。纳入我们荟萃分析的是涉及静脉注射（IV）TXA对接受髋部手术患者的疗效和安全性的随机对照试验（RCT）。终点包括总失血量、隐性失血量、术后血红蛋白下降、输血率、血栓形成事件发生率和手术时间。本次荟萃分析按照Cochrane综述手册和PRISMA声明的指南进行。使用STATA V.12.0软件进行数据汇总。
结果
纳入8项RCT，涉及598名参与者。本次荟萃分析表明，与对照组相比，静脉注射TXA组的总失血量更少（加权平均差[WMD]=-277，95%置信区间：-335至-220，P=.000），隐性失血量更少（WMD=-246，95%置信区间：-252至-241，P=.000），术后血红蛋白下降更低（WMD=-1.36，95%置信区间：-1.84至-0.88，P=.000），输血率更低（风险差[RD]=-0.19，95%置信区间：-0.27至-0.11，P=.000）。在血栓形成事件发生率（RD=0.02，95%置信区间=-0.01至0.05，P=.262）和手术时间（WMD=-0.7，95%置信区间：-3.3至1.9，P=.6）方面未发现显著差异。
结论
已充分证实，全身应用TXA可降低髋部骨折手术中的失血量和输血率。但最佳方案、剂量和时机仍需进一步研究。此外，在广泛推荐静脉注射TXA用于髋部骨折手术之前，需要更多大型、高质量的随机对照研究关注其应用安全性。
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