局部应用纤维蛋白胶对全髋关节置换术止血效果有效性和安全性的Meta分析

Topical hemostatic efficacy and safety of fibrin sealant in primary total hip arthroplasty： a metaanalysis

目的通过Meta分析评价局部应用纤维蛋白胶（Fs）治疗全髋关节置换术（THA）失血的有效性及安全性。方法计算机检索CochraneLibrary、Medline、Embase、Pubmed、Ovid等英文数据库以及中国生物医学文献数据库、维普中国科技期刊数据库、万方数据库及中国知网数据库中所有关于局部应用Fs治疗THA术后出血的随机对照试验，使用Cochrane风险评估工具对纳入的文献进行方法学质量评价，使用RevmanManager5．30进行Meta分析。结果共纳入7篇文献，纳入患者473例，其中局部应用Fs组229例，对照组244例。局部应用FS可以减少THA术后失血量（WMD=-131．89，95％CI-258．11～-5．66，P〈0．05）、输血率（RD=-0．06，95％CI-0．17-0．05，P〉0．05）、引流管中失血量（WMD=-93．44，95％CI-171．58～-15．29，P〈0．05）、引流量（WMD=-32．59，95％CI-64．19～-0．99，P〈0．05）及血红蛋白（Hb）下降值（SMD=-0．31，95％CI-0．53～-0．09，P〈0．05）。两组患者术后深静脉血栓（DVT）发生率、感染发生率差异无统计学意义（P〉0．05）。结论局部应用FS可以减少THA患者术后失血量、引流量及Hb下降值，而不增加术后血栓形成及感染发生的概率。

Objective To evaluate the topical hemostatic efficacy and safety of fibrin sealant （FS） in primary total hip arthroplasty （THA） through a recta-analysis. Methods All randomized controlled trials about evaluating the efficacy and safety of topical administration of FS during THA were searched on the database of Cochrane Library, Medline, Embase, PubMed, Ovid, CBM, VIP, Wanfang data and CNKI. Methodological quality assessment of the included literatures was performed using the Cochrane risk evaluation tool. Software Revman 5.30 was used for the meta-analysis. Results A total of seven literatures involving 473 patients were identified. There were 229 patients in FS group and 244 patients in control group. Compared to control group, topical use of FS was effective to reduce total blood loss （ WMD = -131.89,95 % C1-258.11 - -5.66, P 〈 0.05 ）, transfusion rate （RD = -0.06,95 % CI 43.17 -0.05 ,P 〉0.05 ）, tube blood loss （ WMD = -93.44,95% CI -171.58 - -15.29 ,P 〈 0.05 ）, drain volume （ WMD = -32.59,95% CI -（34. 19 - 43.99, P 〈 0.05 ） and reduced level of hemoglobin （ Hb ） （SMD =43.31,95% CI 43.53 - 43.09,P 〈0.05）. Incidence of deep vein thrombosis （DVT） and infection did not differ significantly between the two groups （ P 〉 0.05 ）. Conclusion Topical use of FScan effectively reduce blood loss and transfusion rate after THA, but the rate of embolism events and infection not increased correspondingly.