在全膝关节置换患者中，引流管夹闭与氨甲环酸联合应用是否优于单独使用其中任何一种？：一项随机对照试验的荟萃分析。
Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?: A meta-analysis of randomized controlled trials.
作者信息
Han Yan-Hong, Huang He-Tao, Pan Jian-Ke, Zeng Ling-Feng, Liang Gui-Hong, Liang Hao-Dong, Yang Wei-Yi, Guo Da, Liu Jun
机构信息
Second School of Clinical Medicine, Guangzhou University of Chinese Medicine Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine) Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China.
出版信息
Medicine (Baltimore). 2018 Sep;97(36):e11573. doi: 10.1097/MD.0000000000011573.
BACKGROUND
To compare the efficacy and safety of the combined application of both drain-clamping and tranexamic acid (TXA) versus the single use of either application in patients with total-knee arthroplasty (TKA).
METHODS
Databases (EMBASE, PubMed, Cochrane Library, Web of Sciences, the Google database, and the Ovid database) were searched from their inception through April 2018 for randomized controlled trials (RCTs) comparing the combined application of both drain-clamping and TXA versus single use of either application in patients with TKA. The Cochrane risk of bias (ROB) tool was used to assess the methodologic quality. The primary outcomes were blood loss in drainage, total blood loss, transfusion rate, and hemoglobin decline. The secondary outcomes were postoperative complications, the Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The statistical analysis was performed with RevMan 5.3.5 software.
RESULTS
A total of five RCTs (479 participants) were included in our meta-analysis. The present meta-analysis indicated that significant differences existed in the total blood loss (mean difference [MD] = -145.86, 95% confidence interval [CI]: -228.64 to -63.08, P = .0006), blood loss in drainage (MD = -169.06, 95% CI: -248.56 to -89.57, P < .0001), hemoglobin decline (MD = -0.66, 95% CI: -1.00 to -0.33, P = .0001), and transfusion rate (MD = 0.44, 95% CI: 0.26-0.75, P = .002) between the groups. However, regarding postoperative complications, no significant differences were found between the 2 groups in the KSS and the WOMAC score (P > .05).
CONCLUSION
Combined application of both drain-clamping and TXA was associated with significant reductions in blood loss in drainage, total blood loss, hemoglobin decline, and the need for transfusion. However, high-quality, well-designed RCTs with long-term follow-up are still required.
背景
比较全膝关节置换术（TKA）患者中联合应用引流管夹闭和氨甲环酸（TXA）与单独使用其中一种方法的疗效和安全性。
方法
检索数据库（EMBASE、PubMed、Cochrane图书馆、Web of Sciences、谷歌数据库和Ovid数据库）自建库至2018年4月的随机对照试验（RCT），比较TKA患者联合应用引流管夹闭和TXA与单独使用其中一种方法的效果。采用Cochrane偏倚风险（ROB）工具评估方法学质量。主要结局指标为引流量、总失血量、输血率和血红蛋白下降情况。次要结局指标为术后并发症、膝关节协会评分（KSS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。使用RevMan 5.3.5软件进行统计分析。
结果
我们的荟萃分析共纳入5项RCT（479名参与者）。目前的荟萃分析表明，两组之间在总失血量（平均差[MD]=-145.86，95%置信区间[CI]：-228.64至-63.08，P=.0006）、引流量（MD=-169.06，95%CI：-248.56至-89.57，P<.0001）、血红蛋白下降（MD=-0.66，95%CI：-1.00至-0.33，P=.0001）和输血率（MD=0.44，95%CI：0.26 - 0.75，P=.002）方面存在显著差异。然而，关于术后并发症，两组在KSS和WOMAC评分方面未发现显著差异（P>.05）。
结论
联合应用引流管夹闭和TXA与引流量、总失血量、血红蛋白下降以及输血需求的显著减少相关。然而，仍需要高质量、精心设计且有长期随访的RCT。
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