氨甲环酸在预防人工关节置换术后感染和手术部位感染中的应用：系统评价和荟萃分析。
Tranexamic acid administration for the prevention of periprosthetic joint infection and surgical site infection: a systematic review and meta-analysis.
机构信息
Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
出版信息
Arch Orthop Trauma Surg. 2023 Nov;143(11):6883-6899. doi: 10.1007/s00402-023-04914-x. Epub 2023 Jun 24.
INTRODUCTION
Tranexamic acid (TXA) has been widely utilized to reduce blood loss and allogeneic transfusions in patients who undergo lower limb arthroplasty. In recent years, there have been several articles reporting the incidence of periprosthetic joint infection (PJI) as a primary outcome of TXA administration, but no meta-analysis has been conducted to date. The present systematic review and meta-analysis evaluated the efficacy of TXA administration in preventing PJI and surgical site infection (SSI).
MATERIALS AND METHODS
Pubmed, CINAHL, and the Cochrane Library bibliographic databases were searched for studies published by May 24, 2022, that evaluated the effects of TXA on PJI and SSI. Two researchers screened the identified studies based on the PRISMA flow diagram. The quality of each randomized clinical trial was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB2.0), and the quality of cohort and case-control studies was assessed by risk of bias for nonrandomized studies (ROBANS-I).
RESULTS
Of the 2259 articles identified from the database search, 31 were screened and selected. Treatment with TXA significantly reduced the incidence of overall infection, including PJI, SSI, and other infections (OR 0.55; 95% CI 0.49-0.62) (P < 0.00001), and that of PJI alone (OR 0.53; 95% CI 0.47-0.59) (P < 0.00001). TXA reduced the incidence of overall infection in patients who underwent total hip arthroplasty (THA; OR 0.51; 95% CI: 0.35-0.75) (P = 0.0005) and total knee arthroplasty (TKA; OR 0.55; 95% CI: 0.43-0.71) (P < 0.00001). Intravenous administration of TXA reduced the incidence of overall infection (OR 0.59; 95% CI 0.47-0.75) (P < 0.0001), whereas topical administration did not.
CONCLUSIONS
Intravenous administration of TXA reduces the incidence of overall infection in patients undergoing both THA and TKA.
LEVEL OF EVIDENCE
Level III.
简介
氨甲环酸（TXA）已被广泛用于减少下肢关节置换术后患者的失血和异体输血。近年来，有几篇文章报道了将假体周围关节感染（PJI）作为 TXA 给药的主要结果的发生率，但迄今为止尚未进行荟萃分析。本系统评价和荟萃分析评估了 TXA 给药预防 PJI 和手术部位感染（SSI）的疗效。
材料和方法
检索了 Pubmed、CINAHL 和 Cochrane 图书馆书目数据库，以获取截至 2022 年 5 月 24 日评估 TXA 对 PJI 和 SSI 影响的研究。两名研究人员根据 PRISMA 流程图筛选确定的研究。使用随机临床试验的 Cochrane 偏倚风险工具版本 2（ROB2.0）评估每个随机临床试验的质量，并使用非随机研究的偏倚风险（ROBANS-I）评估队列和病例对照研究的质量。
结果
从数据库搜索中确定了 2259 篇文章，筛选并选择了 31 篇。TXA 治疗可显著降低总感染发生率，包括 PJI、SSI 和其他感染（OR 0.55；95%CI 0.49-0.62）（P<0.00001），以及单独 PJI（OR 0.53；95%CI 0.47-0.59）（P<0.00001）。TXA 降低了全髋关节置换术（THA；OR 0.51；95%CI：0.35-0.75）（P=0.0005）和全膝关节置换术（TKA；OR 0.55；95%CI：0.43-0.71）（P<0.00001）患者的总感染发生率。静脉内给予 TXA 可降低总感染发生率（OR 0.59；95%CI 0.47-0.75）（P<0.0001），而局部给予 TXA 则不能。
结论
静脉内给予 TXA 可降低接受 THA 和 TKA 的患者的总感染发生率。
证据水平
III 级。
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