抑肽酶对原位肝移植术输血量及术后转归影响的meta分析

The requirement of transfusion and postoperative outcomes in OLT:a meta-analysis on aprotinin

目的研究抑肽酶在原位肝移植术中能否减少对血制品的需要量,以及与术后出血再手术率,血管栓塞发生以及死亡率等的关系。方法以Medline电子数据库作为主要资料来源,剔除无关资料,整理原始文件并摘录相关数据,对于血制品需要量的相关数据用固定效应模型,进行加权均数差(WMD)计算,并对结果进行z检验,对于术后转归的相关数据采用固定效应模型Fleiss法进行优势比(ORi)的检验并进行合并。结果共7篇文献满足纳入标准。其中有关血制品需要量的文献4篇(n=321),有关术后事件的文献5篇(n=477)。术中红细胞需要量,抑肽酶组与对照组相比差异有统计学意义(WMD=-1.80units,95%CI为-3.38～-0.22)。术中对新鲜冰冻血浆需要量抑肽酶组与对照组差异有统计学意义(WMD=-3.99units,95%CI为-6.47～-1.50)。而在围术期死亡率、术后出血再次手术率及术后血栓发生率方面,抑肽酶组与对照组差异无统计学意义。结论抑肽酶能够减少原位肝移植术中对血制品的需要量。但对术后死亡率、出血再次手术率及术后血栓形成率方面无明显影响。

Objective To study the effect of aprotinin used in orthotopic liver transplantation （OLT） on the intraoperative requirement of blood products and on the incidence of laparotomy for bleeding,thromboembolic events and mortality. Methods A systematic review of the literatures was performed in the electronic database of Medline. Citations that do not fit our study were excluded. The citations were unscrambled and the data were recorded. Weighted mean differences（WMD） of the data on the requirements of blood products were tested using the fixed effect model. Z test was performed to examine their reliability and Fleiss method of fixed effect model was used to analyze the data on postoperative events,and their odds ratio（ORi） was tested and merged as well. Results seven citations were involved in this study. Among them, the requirement of blood products was reported in 4 studies of 321 patients,while the postoperative events were reported in 5 studies of 477 patients. The effect of aprotinin on the requirement of red blood cell and fresh frozen plasma was statistically significant（WMD= - 1.80 units, 95% CI, - 3.38 to - 0.22; WMD= - 3.99units, 95% CI, - 6.47 to -1.50,respectively）. However, no significant difference was indicated on the incidence of laparotomy for bleeding,thromboembolic events,and mortality between the two groups. Conclusion Aprotinin can reduce the intraoperative requirement of blood products in OLT, and has no significant effect on the incidence of laparotomy for bleeding, thromboembolic events,and mortality.