血栓弹力图指导心脏手术输血对术后出血量的影响meta分析

Meta-analysis of the Effect of Thrombelastography Guided Cardiac Surgery Transfusion on Postoperative Bleeding

目的评价血栓弹力图(thromboelastography,TEG)与常规检测指导心脏手术输血对术后出血量的影响,为治疗决策提供依据。方法以"Thromboelastography、TEG、血栓弹力图、血栓弹力描记图"为检索词检索Pub Med、Embase、The Cochrane Library、中国生物医学文献数据库和中国期刊网全文数据库建库至2015年2月关于TEG与常规检测指导心脏手术输血对术后出血量影响的随机对照试验或回顾性队列研究,对符合纳入标准的文献提取资料、评估方法学质量,并采用Rev Man5.3软件进行meta分析。结果最终纳入7篇文献共计689例患者,其中5篇为高质量研究,2篇为低质量研究。meta分析结果显示:TEG与常规检测指导心脏手术输血对术后出血量的影响差异有统计学意义[WMD=-45.67,95%CI(-80.32,-11.03),P<0.05]。结论与常规检测指导心脏手术输血比较,TEG指导能明显减少患者术后出血量。

Objective To evaluate thrombelastography （TEG） and routine testing guided cardiac surgery transfusion on postoperative bleeding, and to provide evidence for the treatment strategies. Methods The randomized controlled trials （RCT） or retrospective cohort study （RC） about cardiac surgery transfusion guided by TEG and routine testing on postopera- tive bleeding were searched by Thromboelastography, TEG, and Thrombelastogram Surgery as the search term on PubMed, Embase, the Coehrane Library, Chinese Biomedical Literature Database （CBM） and China Journal Full-text Database （CNKI） from the establishment of the data base to February 2015. By extracting data and assessing methodological quality, meta-analysis was conducted using the Cochrane Collaboration RevMan 5.3 software. Results Seven articles and 689 patients were included. Meta-analysis indicated that there was significant difference between TEG and routine testing guided cardiac surgery transfusion on postoperative bleeding [ WMD = - 45.67, 95% C]（ - 80.32, - 11.03） , P 〈 0.05 ]. Conclusion Compared with routine testing in guiding transfusion, TEG can significantly reduce the amount of bleeding after cardiac surgery in guiding transfusion.