全膝关节置换中应用氨甲环酸有效性及安全性的Meta分析

Meta-analysis for the efficacy and safety of tranexamic acid in total knee arthroplasty

背景:目前关于全膝关节置换术中使用氨甲环酸可以减少出血的临床报道较多,但争议较大,膝关节置换术中使用氨甲环酸是否一定可以减少置换后出血并增加围手术期的血栓形成风险,目前尚缺乏系统的评价。目的:以Meta分析的方法评价全膝关节置换术中使用氨甲环酸的安全性和有效性。方法:在国内外数据库中检索关于关于氨甲环酸减少全膝关节置换术出血量的临床随机对照试验,并查阅所有检出文献和相关综述的参考文献作为补充资料。根据纳入、排除标准筛选文献和质量评价,随后采用RevM an 5.1软件进行统计分析,氨甲环酸组与安慰剂对照组失血量采用均数差(MD)评价,输血率、深静脉血栓发生率采用危险度(RR)评价。结果与结论:共纳入随机对照试验17篇。Meta分析结果显示,与对照组相比,氨甲环酸能够降低全膝关节置换患者总失血量[MD=-314.96,95%CI(-448.76,-181.16)]、术后失血量[MD=-417.72,95%CI(-508.87,-326.56)],降低输血率[RR=0.43,95%CI(0.37,0.51)],而两组深静脉血栓[RR=0.98,95%CI(0.38,2.52)]、肺栓塞症发生率差异无显著性意义。提示氨甲环酸能够降低全膝关节置换失血量及输血率,不增加深静脉血栓肺栓塞症和感染的发生风险。

BACKGROUND：Increasing evidence has found that, tranexamic acid could reduce blood loss during total knee arthroplasty, but the efficacy and safety remain controversial. Whether tranexamic acid can reduce blood loss and increase the risk of thrombosis during the perioperative period, needs further systemic evaluation. OBJECTIVE：To explore the safety and effectiveness of tranexamic acid in the total knee arthroplasty through a meta-analysis. METHODS：Randomized control ed trials on tranexamic acid in total knee arthroplasty were retrieved from relevant databases. Al retrieved documents and references were used as supplementary information. According to the inclusion and exclusion criteria, retrieved documents were screened and the quality was assessed, then meta-analyses were performed by using the RevMan 5.1 software. The mean difference of blood loss, the risk ratio of transfusion, and the incidence of deep vein thrombosis and pulmonary embolism in the tranexamic acid and control groups were calculated. RESULTS AND CONCLUSION：Total y 17 randomized control ed studies were included. Meta-analysis results showed that, tranexamic acid significantly reduced the total blood loss [MD=-314.96, 95%CI（-448.76,-181.16）], postoperative blood loss [MD=-417.72, 95%CI（-508.87,-326.56）], and the proportion of patients requiring blood transfusion [RR=0.43, 95%CI（0.37, 0.51）], when compared with the control group. The incidence of deep vein＆nbsp;thrombosis [RR=0.98, 95%CI（0.38, 2.52）] and pulmonary embolism showed no significant difference between the two groups. Tranexamic acid could reduce blood loss and blood transfusion for patients undergoing total knee arthroplasty, without increasing the risk of deep vein thrombosis and infection.