院前使用氨甲环酸对出血性创伤患者死亡率的影响：系统评价和荟萃分析。
The impact of prehospital TXA on mortality among bleeding trauma patients: A systematic review and meta-analysis.
机构信息
From the Centre for Trauma Science, Blizard Institute (A.A., E.C., J.R., Z.P., R.D.), Queen Mary University, London, United Kingdom; and Emergency Medical Services Department, Faculty of Applied Medical Sciences (A.A.), Jazan University, Kingdom of Saudi Arabia.
出版信息
J Trauma Acute Care Surg. 2021 May 1;90(5):901-907. doi: 10.1097/TA.0000000000003120.
BACKGROUND
Tranexamic acid (TXA) is an antifibrinolytic drug associated with improved survival among trauma patients with hemorrhage. Tranexamic acid is considered a primary hemostatic intervention in prehospital for treatment of bleeding alongside blood product transfusion.
METHODS
A systematic review and meta-analysis was conducted to investigate the impact of prehospital TXA on mortality among trauma patients with bleeding. A systematic search was conducted using the National Institute for Health and Care Excellence Healthcare Databases Advanced Search library which contain the following of databases: EMBASE, Medline, PubMed, BNI, EMCARE, and HMIC. Other databases searched included SCOPUS and the Cochrane Central Register for Clinical Trials Library. Quality assessment tools were applied among included studies; Cochrane Risk of Bias for randomized control trials and Newcastle-Ottawa Scale for cohort observational studies.
RESULTS
A total of 797 publications were identified from the initial database search. After removing duplicates and applying inclusion/exclusion criteria, four studies were included in the review and meta-analysis which identified a significant survival benefit in patients who received prehospital TXA versus no TXA. Three observational cohort and one randomized control trial were included into the review with a total of 2,347 patients (TXA, 1,169 vs. no TXA, 1,178). There was a significant reduction in 24 hours mortality; odds ratio (OR) of 0.60 (95% confidence interval [CI], 0.37-0.99). No statistical significant differences in 28 days to 30 days mortality; OR of 0.69 (95% CI, 0.47-1.02), or venous thromboembolism OR of 1.49 (95% CI, 0.90-2.46) were found.
CONCLUSION
This review demonstrates that prehospital TXA is associated with significant reductions in the early (24 hour) mortality of trauma patients with suspected or confirmed hemorrhage but no increase in the incidence of venous thromboembolism.
LEVEL OF EVIDENCE
Systematic review and meta-analysis. Level I.
背景
氨甲环酸（TXA）是一种抗纤维蛋白溶解药物，与出血创伤患者的存活率提高有关。氨甲环酸被认为是院前治疗出血的主要止血干预措施，与输血液制品一起使用。
方法
进行了系统评价和荟萃分析，以调查院前使用 TXA 对出血创伤患者死亡率的影响。使用国家卫生与保健卓越研究所医疗保健数据库高级搜索库进行系统搜索，该库包含以下数据库：EMBASE、Medline、PubMed、BNI、EMCARE 和 HMIC。搜索的其他数据库包括 SCOPUS 和 Cochrane 临床试验中心注册库。对纳入的研究应用质量评估工具；随机对照试验的 Cochrane 偏倚风险和队列观察研究的纽卡斯尔-渥太华量表。
结果
从初始数据库搜索中确定了 797 篇出版物。在去除重复项并应用纳入/排除标准后，有 4 项研究纳入了综述和荟萃分析，结果表明，接受院前 TXA 治疗的患者与未接受 TXA 治疗的患者相比，生存率显著提高。综述包括 3 项观察性队列研究和 1 项随机对照试验，共有 2347 名患者（TXA，1169 例；无 TXA，1178 例）。24 小时死亡率显著降低；优势比（OR）为 0.60（95%置信区间 [CI]，0.37-0.99）。28 天至 30 天死亡率无统计学显著差异；OR 为 0.69（95%CI，0.47-1.02），或静脉血栓栓塞 OR 为 1.49（95%CI，0.90-2.46）。
结论
本综述表明，院前使用 TXA 可显著降低疑似或确诊出血创伤患者的早期（24 小时）死亡率，但不会增加静脉血栓栓塞的发生率。
证据水平
系统评价和荟萃分析。一级。
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