Rangasamy Karthick, Neradi Deepak, Gopinathan Nirmal Raj, Gandhi Komal Anil, Sodavarapu Praveen
Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Clin Orthop Trauma. 2021 Jun 29;20:101488. doi: 10.1016/j.jcot.2021.101488. eCollection 2021 Sep.
Cerebral palsy (CP) children undergoing hip reconstruction are more prone to blood loss during surgery due to poor nutritional status, antiepileptic medication intake, depletion of clotting factors, and the extent of surgery involved. We conducted this present review to analyze whether antifibrinolytics during hip surgery in CP children would reduce surgical blood loss and transfusion requirements.
Three databases (PubMed, EMBASE, and Cochrane library) were searched independently for publications mentioning the use of antifibrinolytics during hip reconstruction surgery in CP children. The primary outcome was to compare the surgical blood loss with and without antifibrinolytics use. Secondary outcomes were transfusion requirements, drop in hemoglobin level, length of hospital stay, and complication rates.
All five studies (reporting 478 patients) published on this topic were found eligible based on inclusion criteria and were included for final analysis. : In three of the included studies, antifibrinolytics use resulted in a significant reduction in total blood loss with a mean difference (MD) of -151.05 mL (95% CI -272.30 to -29.80, p = 0.01). In the other two studies although statistically not significant, antifibrinolytics use reduces estimated blood loss (MD: 3.27, 95% CI -21.44 to 14.91, p = 0.72). We observed that in the antifibrinolytics group, there was a reduction in total blood transfusion requirements (OD: 0.70, 95% CI 0.35 to 1.37, p = 0.29), and a drop in haemoglobin level (MD: 0.16, 95% CI -0.62 to 0.30, p = 0.49) but statistically not significant. No adverse effects related directly to antifibrinolytics were noticed in all five studies.
Only two out of five included studies favored the use of antifibrinolytics in CP children undergoing hip reconstruction. The evidence synthesized on this meta-analysis is also not sufficient enough to support its routine use in this cohort of children for hip reconstruction surgery. High-quality studies with adequate sample size to determine the effective and safe dosage, timing, and cost involved of different antifibrinolytics are the need of the hour.
Ⅲ.
由于营养状况差、服用抗癫痫药物、凝血因子消耗以及手术范围等因素，接受髋关节重建手术的脑瘫（CP）患儿在手术过程中更容易失血。我们进行了本次综述，以分析CP患儿髋关节手术中使用抗纤溶药物是否会减少手术失血和输血需求。
独立检索三个数据库（PubMed、EMBASE和Cochrane图书馆），查找提及CP患儿髋关节重建手术中使用抗纤溶药物的出版物。主要结局是比较使用和不使用抗纤溶药物时的手术失血量。次要结局包括输血需求、血红蛋白水平下降、住院时间和并发症发生率。
基于纳入标准，发现所有关于该主题发表的五项研究（报告了478例患者）均符合条件，并纳入最终分析。在三项纳入研究中，使用抗纤溶药物使总失血量显著减少，平均差值（MD）为-151.05 mL（95%可信区间 -272.30至-29.80，p = 0.01）。在另外两项研究中，尽管在统计学上不显著，但使用抗纤溶药物减少了估计失血量（MD：3.27，95%可信区间 -21.44至14.91，p = 0.72）。我们观察到，在抗纤溶药物组中，总输血需求有所减少（比值比：0.70，95%可信区间0.35至1.37，p = 0.29），血红蛋白水平有所下降（MD：0.16，95%可信区间 -0.62至0.30，p = 0.49），但在统计学上不显著。在所有五项研究中均未发现与抗纤溶药物直接相关的不良反应。
五项纳入研究中只有两项支持在接受髋关节重建的CP患儿中使用抗纤溶药物。本次荟萃分析综合的证据也不足以支持在该队列儿童髋关节重建手术中常规使用抗纤溶药物。目前需要进行高质量、样本量充足的研究，以确定不同抗纤溶药物的有效和安全剂量、使用时机以及相关成本。
Ⅲ级。
