抗血小板治疗冠状动脉旁路移植术患者围手术期抗纤溶治疗效果的荟萃分析

A meta-analysis on efficacy of antifibrinolytic agents during perioperative period in patients undergoing coronary artery bypass grafting treated with antiplatelet agents

目的评价实施抗血小板治疗的冠状动脉旁路移植术（CABG）患者围手术期抗纤溶治疗的效果。方法采用Cochrane系统评价方法，检索PubMed、EMbase、Highwire、CENTREN及其下属各临床注册试验数据中心数据库、中国生物医学文献数据库、中国期刊全文数据库。收集2000至2010年，实施抗血小板治疗（包括抑肽酶和氨甲环酸）的CABG患者围手术期抗纤溶治疗有效性方面的临床随机对照试验。按Cochrane系统评价方法，由2名评价者独立评价所纳入研究的文献质量，提取有效数据后，采用RevMan5．0软件进行荟萃分析。结果纳入11项研究，共计725例患者。荟萃分析显示：与空白对照治疗比较，实施抗血小板治疗CABG患者围手术期抗纤溶治疗的术后24h出血量较少（MD=-506．52ml，95％CI：-351．52～-261．52，P〈0．01），需要输血的人数较少（OR=0．37，95％CI：0．26～0．51，P〈0．01），平均输血量较少（MD=-0．59U，95％CI：-0．69--0．50，P〈0．01），二次手术人数较少（OR=0．27，95％CI：0．09—0．78，P=0．02），血栓事件的发生率较低（OR=0．49，95％CI：0．25～0．97，P=0．04）。结论实施抗血小板治疗的CABG患者围手术期合理抗纤溶治疗可以有效减少术后24h出血量、输血量和二次手术，并且不增加血栓事件的发生率。

Objective To evaluate the efficacy of antifibrinolytic agents in coronary artery bypass grafting （CABG） patients receiving antiplatelet. Methods We searched PubMed, EMbase, Highwire, CENTREN and its affiliated clinical trial registration data center, CBMdisc and CNKI databases from 2000 to 2010. Randomized controlled trials investigating the efficacy of anti-fibrinolytic agents （aprotinin and tranexamie acid ） in CABG patients were identified. Study selection and meta-analysis were conducted according to the Cochrane Handbook for systematic reviews. Date were extracted from these trials by 2 reviewers independently and analyzed by RevMan 5.0 software. Result Eleven RCT trials （ n = 725 ） were included and data confirmed the efficacy of antifibrinolytic therapy in terms of reducing bleeding within 24 hours after operation（MD = - 306.5 ml, 95% CI： - 351.52 to - 261.52,P 〈 0. 01 ）, number of patients who need blood transfusion （ OR = 0. 37, 95% CI：0. 26 to 0. 51, P 〈 0. 01 ） , amount of blood transfusion （ MD = - 0. 59 U, 95 % CI： - 0. 69 to - 0.50, P 〈 0. 01 ）, surgical re-exploration （ OR = 0. 27,95 % CI： 0.09 to 0. 78, P = 0. 02）, and thrombotic events （ OR = 0. 49,95 % CI：0. 25 to 0. 97, P = 0. 04） in CABG patients receiving antiplatelet, while compared with blank treatment. Conclusion This analysis showed that antifibrinolytic agents are effective for reducing bleeding within 24 hours after operation, amount of blood transfusion, surgical re-exploration and do not increase the incidence of thrombotic events in CABG patients receiving antiplatelet before operation.