自体输血在全膝关节置换术应用的Meta分析

The application of autologous blood retransfusion after total knee arthroplasty: A Meta-analysis

目的评价自体输血在全膝关节置换术后应用的有效性与安全性。方法运用计算机检索Pub Med、Cochrane Library、EMBASE、BIOSIS、Ovid databases、中国知网（CNKI）、维普数据库、万方数据库以及手工检索相关文献的参考文献。收集公开发表自1900年01月01日—2017年6月1日的全膝关节置换围手术期应用自体血回输技术与未使用自体血回输技术的随机对照中英文文献。严格按照改良后的Jadad评分标准评价文献质量,通过提取符合纳入条件的文献资料,并使用Rev Man5.1.0软件做统计分析。结果从858篇文献中排除489篇重复文献,并通过浏览摘要及阅读全文后纳入7个随机对照试验文献,其中英文文献6篇,中文文献1篇。根据改良后的Jadad评分标准,有4篇文献为高质量文献,3篇文献为低质量文献。Meta分析：术前血红蛋白（Hb）（g/d L）行自体输血的全膝关节置换术患者为12.8—14.0、未行自体输血的为12.7—14.2,2组权重均值（WMD）=-0.05、95%CI为-0.23—0.13;术后d1 Hb（g/d L）自体输血组Hb为9.9—11.6,未行自体输血的为9.6—11.3,2组WMD=0.17、95%CI为-0.09—0.44;术后d3 Hb（g/d L）自体输血组为10.0—11.0,未行自体输血的为9.8—10.8,2组WMD=0.30、95%CI为-0.11—0.70;术后d7 Hb（g/d L）自体输血组为9.6—10.7,未行自体输血的为9.8—10.5,2组WMD=-0.05、95%CI为-0.32—0.23（P〉0.05）;但是自体血回输组需要输异体血血概率的相对危险度（RR）=0.39、95%CI为0.28—0.55（P〈0.01）,其各种并发症的RR=0.86、95%CI为0.41—1.79（P〉0.05）。结论自体输血可以减少全膝关节置换术患者输注同种异体血,如果患者术前Hb低于正常值且存在自体输血的条件,全膝关节置换术中可使用自体血回输技术。

Objective To assess the clinical efficiency,safety and potential advantages of autologous blood retransfusion after total knee arthroplasty. Methods Related publications,including Chinese and English,were retrieved（ from January01,1990 to June 01,2017） from Pub Med,Cochrane Library,EMBASE,BIOSIS,Ovid,CNKI,Vip,Wanfang Data,and manual search with randomized controlled trials（ RCT） to compare the use of autologous blood retransfusion after total knee arthroplasty. Methodological quality of the trials was assessed by the modified Jadad standard. Qualified publications were extracted. Statistical software Revman 5. 1. 0 was used for data-analysis. Results A total of 7 randomized controlled trials were included,including 6 English and 1 Chinese from a total 858 literatures. There were 4 studies that qualified as level A and 3 studies as level B. The results of meta-analysis showed that the hemoglobin of perioperative period presented no significant difference. The rate of blood transfusion was lower in the autologous blood retransfusion group（ RR = 0. 39,95% CI： 0. 28 to0. 55,P〈0. 00001）. No significant difference on complication（ RR = 0. 86,95% CI： 0. 41 to 1. 79,P = 0. 68） between group was found. Conclusion In general,the use of allogeneic blood will reduce if the autologous blood transfusion is used. The patient with low hemoglobin should consider autologous blood transfusion if the condition allows.