Wu Yuan-Gang, Zeng Yi, Hu Qin-Sheng, Bao Xian-Chao, Xiong Hua-Zhang, Shen Bin
Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Orthop Surg. 2018 Nov;10(4):287-295. doi: 10.1111/os.12404. Epub 2018 Nov 8.
The present study assessed the effectiveness of the combined administration of tranexamic acid (TXA) plus low-dose epinephrine in primary total knee arthroplasty (TKA). We searched the following Chinese electronic databases: China National Knowledge Infrastructure and WanFang Data. We also searched the following English electronic databases: PubMed, Embase, Web of Science, and Central Register of Controlled Trials. To search for additional eligible studies, we also used Google's search engine. All randomized controlled trials (RCT) comparing TXA plus low-dose epinephrine (Combined group) and TXA alone in TKA were systematically searched. The primary outcomes were total blood loss, hidden blood loss, the requirement for transfusion, maximum hemoglobin (Hb) drop, and deep venous thrombosis (DVT). Drainage volume, operation time, length of stay, hospital for special surgery (HSS) score, and range of motion (ROM) were considered as secondary outcomes. Subgroup analyses were performed to assess the benefits of using a tourniquet and the application routes of topical or intravenous TXA between the two groups. Statistical analysis was assessed using RevMan 5.3 software. Four independent RCT were included involving 426 patients, with 213 patients in the Combined group and 213 patients in the TXA alone group. In the Combined group there was significant reduction in total blood loss (MD, 204.70; 95% CI, -302.76 to -106.63; P < 0.0001), hidden blood loss (MD, 185.63; 95% CI, -227.56 to -143.71; P < 0.00001), drainage volume (MD, 93.49; 95% CI, -117.24 to -69.74; P < 0.00001), and maximum Hb drop (MD, 5.33, 95% CI, -6.75 to -3.91; P < 0.00001). No statistical differences were found postoperatively in terms of the requirement for transfusion (risk ratio, 0.52; 95% CI, 0.26-1.04; P = 0.06), operation time (MD, 0.85; 95% CI, -2.62 to 4.31; P = 0.63), length of stay (MD, -0.02; 95% CI, -0.52 to 0.47; P = 0.93), HSS score (MD, 0.78; 95% CI, -0.36 to 1.92; P = 0.18), and ROM (MD, 1.40; 95% CI, -1.01 to 3.81; P = 0.26), and not increasing the risk of DVT (risk ratio, 1.00; 95% CI, 0.33 to 3.02; P = 1.00) in the two groups. This meta-analysis demonstrated that the administration of tranexamic acid plus low-dose epinephrine is a safe and efficacious treatment to reduce total blood loss, hidden blood loss, drainage volume, and maximum Hb drop in primary TKA, without increasing the risk of DVT in primary THA.
本研究评估了氨甲环酸（TXA）联合低剂量肾上腺素在初次全膝关节置换术（TKA）中的有效性。我们检索了以下中文电子数据库：中国知网和万方数据。我们还检索了以下英文电子数据库：PubMed、Embase、Web of Science和Cochrane对照试验中心注册库。为了搜索其他符合条件的研究，我们还使用了谷歌搜索引擎。系统检索了所有比较TXA联合低剂量肾上腺素（联合组）与单独使用TXA在TKA中的随机对照试验（RCT）。主要结局指标为总失血量、隐性失血量、输血需求、最大血红蛋白（Hb）下降幅度和深静脉血栓形成（DVT）。引流量、手术时间、住院时间、美国特种外科医院（HSS）评分和活动范围（ROM）被视为次要结局指标。进行亚组分析以评估使用止血带的益处以及两组之间局部或静脉注射TXA的应用途径。使用RevMan 5.3软件进行统计分析。纳入了4项独立的RCT，涉及426例患者，联合组213例，单独使用TXA组213例。联合组的总失血量（MD，204.70；95%CI，-302.76至-106.63；P<0.0001）、隐性失血量（MD，185.63；95%CI，-227.56至-143.71；P<0.00001）、引流量（MD，93.49；95%CI，-117.24至-69.74；P<0.00001）和最大Hb下降幅度（MD，5.33，95%CI，-6.75至-3.91；P<0.00001）均显著减少。两组术后在输血需求（风险比，0.52；95%CI，0.26 - 1.04；P = 0.06）、手术时间（MD，0.85；95%CI，-2.62至4.31；P = 0.63）、住院时间（MD，-0.02；95%CI，-0.52至0.47；P = 0.93）、HSS评分（MD，0.78；95%CI，-0.36至1.92；P = 0.18）和ROM（MD，1.40；95%CI，-1.01至3.81；P = 0.26）方面未发现统计学差异，且两组均未增加DVT风险（风险比，1.00；95%CI，0.33至3.02；P = 1.00）。这项荟萃分析表明，氨甲环酸联合低剂量肾上腺素给药是一种安全有效的治疗方法，可减少初次TKA中的总失血量、隐性失血量、引流量和最大Hb下降幅度，且不增加初次全髋关节置换术（THA）中DVT的风险。
