氨甲环酸在多节段脊柱手术患者失血控制及输血管理中的作用：一项荟萃分析。

Role of tranexamic acid in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery: A meta-analysis.

作者信息

Zhao Yibo, Xi Chunyang, Xu Wenxiao, Yan Jinglong

机构信息

Department of Orthopedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, PR China.

出版信息

Medicine (Baltimore). 2021 Feb 19;100(7):e24678. doi: 10.1097/MD.0000000000024678.

BACKGROUND

This study aimed to explore the role of tranexamic acid (TXA) in blood loss control and blood transfusion management of patients undergoing multilevel spine surgery.

METHODS

In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library, and Web of Science from inception to June 23rd, 2020. Weighed mean difference (WMD) was used as the effect size for measurement data, and risk ratio for enumeration data. Publication bias was assessed by Begg test.

RESULTS

Totally 23 studies (11 randomized controlled trials and 12 cohort studies) involving 1621 participants were enrolled in this meta-analysis. The results showed that the administration of TXA can significantly decrease the intraoperative [WMD: -215.655, 95%CI: (-307.462, -123.847), P < .001], postoperative [WMD: -69.213, 95%CI: (-104.443, -33.983), P = .001] and total [WMD: -284.388, 95%CI: (-437.66, -131.116), P < .001] volumes of blood loss of patients undergoing multilevel spine surgery. It can also significantly reduce the intraoperative [WMD: -333.775, 95%CI: (-540.45, -127.099), P = .002] and postoperative [WMD: -114.661, 95%CI: (-219.58, -9.742), P = .032] volumes of transfusion. In addition, TXA was found to significantly increase the preoperative [WMD: 0.213, 95%CI: (0.037, 0.389), P = .018] and postoperative [WMD: 0.433, 95%CI: (0.244, 0.622), P < .001] hemoglobin levels as well as the preoperative platelet count [WMD: 14.069, 95%CI: (0.122, 28.015), P = .048].

CONCLUSION

The administration of TXA can effectively reduce blood loss and transfusion, and improve hemoglobin levels and preoperative platelet count in patients undergoing multilevel spine surgery.

背景

本研究旨在探讨氨甲环酸（TXA）在多节段脊柱手术患者失血控制和输血管理中的作用。

方法

在这项荟萃分析中，从创刊至2020年6月23日对PubMed、Embase、Cochrane图书馆和科学网进行了全面的文献检索。加权平均差（WMD）用作测量数据的效应量，风险比用作计数数据的效应量。采用Begg检验评估发表偏倚。

结果

本荟萃分析共纳入23项研究（11项随机对照试验和12项队列研究），涉及1621名参与者。结果表明，使用TXA可显著减少多节段脊柱手术患者的术中失血量[WMD：-215.655，95%CI：（-307.462，-123.847），P<0.001]、术后失血量[WMD：-69.213，95%CI：（-104.443，-33.983），P=0.001]和总失血量[WMD：-284.388，95%CI：（-437.66，-131.116），P<0.001]。它还可显著减少术中输血量[WMD：-333.775，95%CI：（-540.45，-127.099），P=0.002]和术后输血量[WMD：-114.661，95%CI：（-219.58，-9.742），P=0.032]。此外，发现TXA可显著提高术前血红蛋白水平[WMD：0.213，95%CI：（0.037，0.389），P=0.018]和术后血红蛋白水平[WMD：0.433，95%CI：（0.244，0.622），P<0.001]以及术前血小板计数[WMD：14.069，95%CI：（0.122，28.015），P=0.048]。