摘要
目的:利用Meta分析的方法评价氨甲环酸(TXA)对脊柱手术止血的有效性和安全性。方法:检索2017年10月31日前PubMed、Web of Science、ScienceDirect、EmBase、the Cochrane Library、ClinicalTrials等英文数据库以及万方、中国知网、维普等中文数据库中关于脊柱手术围术期静脉输注TXA的随机对照研究,采用改良的Jadad量表评价研究质量,提取总失血量、术中失血量、输血率、输血量和血栓性并发症相关数据,通过RevMan 5.3软件和STATA 14.0软件进行Meta分析。结果:共纳入14篇文献,包含947例研究对象(其中干预组481名,对照组466名),纳入文献的评分在2～6分之间。Meta分析结果显示,围术期静脉给予TXA能够显著降低脊柱手术的总失血量[SMD=-0.83,95%CI:(-1.09,-0.57),P<0.001]、术中失血量[SMD=-0.39,95%CI:(-0.53,-0.25),P<0.001]和输血率[RR=0.70,95%CI:(0.55,0.90),P=0.005],对输血量[SMD=-0.36,95%CI:(-0.72,0.01),P=0.05]和血栓的发生[RR=0.53,95%CI:(0.14,2.03),P=0.35]并无显著影响。结论:脊柱手术围手术期静脉输注TXA能够显著降低围术期的总出血量、术中出血量和输血率,对输血量和血栓的发生并无显著影响。
Objective:To evaluate the efficacy and safety of perioperative intravenous tranexamic acid in spinal surgery by meta-analysis.Methods:Computer-based online search was conducted on the randomized controlled trials of perioperative intravenous tranexamic acid in spinal surgery up to October 31,2017 in PubMed,Web of Science,ScienceDirect,EmBase,the Cochrane Library,ClinicalTrials,Wanfang Database,CNKI and VIP databases.The modified Jadad scale was used to assess the quality of included studies.The following variables were extracted:total blood loss,intraoperative blood loss,ratio and amount of blood transfusion,thrombotic events.Data analysis was conducted via RevMan 5.3 and STATA 14.0.Results:A total of 14 references scaling from 2 to 6 scores were identified,totally 947 patients,including 481 in TXA group and466 in control group.The Meta-analysis showed that compared with the control group,TXA group had a lower total blood loss[SMD=-0.83,95%CI:(-1.09,-0.57),P<0.001],intraoperative blood loss[SMD=-0.39,95%CI:(-0.53,-0.25),P<0.001)]and ratio of blood transfusion[RR=0.70,95%CI:(0.55,0.90),P=0.005].No statistical difference was observed in the amount of blood transfusion[SMD=-0.36,95%CI:(-0.72,0.01),P=0.05]and thrombotic events[RR=0.53,95%CI:(0.14,2.03),P=0.35].Conclusion:Lower total blood loss,intraoperative blood loss and ratio of blood transfusion were closely related to intravenous TXA in spinal surgery.However,there was no statistical influence in the amount of blood transfusion and thrombotic events.
作者
刘文俊
胡海燕
刘亚孔
程林
刘扬
余相地
Liu Wenjun;Hu Haiyan;Liu Yakong;Cheng Lin;Liu Yang;Yu Xiangdi(Department of Spine Surgery,Yichang Central People’s Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Institute of Evidence-Based and Translational Medicine&Yichang Central People’s Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Department of Anesthesiology,Yichang Central People’s Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Department of Anesthesiology,People’s Hospital of Guizhou Province,Guiyang 550002,China)
出处
《巴楚医学》
2018年第1期59-66,共8页
Bachu Medical Journal
