氨甲环酸减少肝外腹部手术围手术期出血的安全性和有效性：荟萃分析。

Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta-analysis.

机构信息

Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK.

出版信息

BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zrab004.

BACKGROUND

Perioperative bleeding is associated with increased morbidity and mortality in patients undergoing elective abdominal surgery. The antifibrinolytic agent tranexamic acid (TXA) has been shown to reduce perioperative bleeding and mortality risk in patients with traumatic injuries, but there is a lack of evidence for its use in elective abdominal and pelvic surgery. This meta-analysis of RCTs evaluated the effectiveness and safety of TXA in elective extrahepatic abdominopelvic surgery.

METHODS

PubMed, Embase, and ClinicalTrial.gov databases were searched to identify relevant RCTs from January 1947 to May 2020. The primary outcome, intraoperative blood loss, and secondary outcomes, need for perioperative blood transfusion, units of blood transfused, thromboembolic events, and mortality, were extracted from included studies. Quantitative pooling of data was based on a random-effects model.

RESULTS

Some 19 studies reporting on 2205 patients who underwent abdominal, pelvic, gynaecological or urological surgery were included. TXA reduced intraoperative blood loss (mean difference -188.35 (95 per cent c.i. -254.98 to -121.72) ml) and the need for perioperative blood transfusion (odds ratio (OR) 0.43, 95 per cent c.i. 0.28 to 0.65). TXA had no impact on the incidence of thromboembolic events (OR 0.49, 0.18 to 1.35). No adverse drug reactions or in-hospital deaths were reported.

CONCLUSION

TXA reduces intraoperative blood loss during elective extrahepatic abdominal and pelvic surgery without an increase in complications.

背景

围手术期出血与择期腹部手术患者的发病率和死亡率增加有关。抗纤维蛋白溶解剂氨甲环酸（TXA）已被证明可降低创伤患者围手术期出血和死亡风险，但尚无其在择期腹部和骨盆手术中应用的证据。本项针对 RCT 的荟萃分析评估了 TXA 在择期肝外腹盆腔手术中的有效性和安全性。

方法

检索了 1947 年 1 月至 2020 年 5 月期间的 PubMed、Embase 和 ClinicalTrials.gov 数据库，以确定相关 RCT。主要结局为术中出血量，次要结局为围手术期输血需求、输血量、血栓栓塞事件和死亡率，从纳入研究中提取这些数据。数据的定量汇总基于随机效应模型。

结果

共纳入了 19 项研究，报道了 2205 例接受腹部、骨盆、妇科或泌尿科手术的患者。TXA 减少了术中出血量（平均差值 -188.35（95%置信区间 -254.98 至 -121.72）ml）和围手术期输血需求（比值比（OR）0.43，95%置信区间 0.28 至 0.65）。TXA 对血栓栓塞事件的发生率无影响（OR 0.49，0.18 至 1.35）。未报告不良药物反应或院内死亡。