全髋关节置换术局部应用氨甲环酸有效性及安全性Meta分析

Efficiency and Safety of Intra-articular Injection of Tranexamic Acid in Total Hip Arthroplasty: A Meta Analysis

目的:评价全髋关节置换术(THA)中关节腔注射氨甲环酸的有效性和安全性。方法:计算机检索Medline(1966年1月—2016年3月)、Embase(1980年1月—2016年3月)、Pubmed(1980年1月—2016年3月)、中国生物医学文献数据库(1966年1月—2016年3月)、维普中国科技期刊数据库(1978年1月—2016年3月)关于THA置换关节腔注射氨甲环酸的临床对照研究,同时检索所有纳入文献的参考文献补充资料,采用Revman5.1软件进行统计分析术后血红素下降值、总失血量、住院天数、围手术期引流量采用均数差评价;输血率、感染率及血栓栓塞事件发生率采用优势比评价。结果:共10篇文献符合纳入标准,试验组与对照组间术后血红素下降值[MD=-0.86,95%CI:-1.32,-0.39,P=0.0003],总失血量[MD=-303.12,95%CI(-412.44,193.80),P<0.000 01],输血率[MD=-0.16,95%CI(-0.24,0.08),P<0.001],均有差异;而住院天数、感染率、深静脉血栓形成及肺栓塞无显著统计学差异。结论:THA关节腔注射氨甲环酸,可降低术后失血量及输血率,同时不增加感染、血栓栓塞事件的风险。

ObjectiveTo evaluate efficiency and safety of topical use of tranexamic acid in patients under-going total hip arthroplasty（THA）.MethodsPotential articles were identified from Medline（1966.1—2016.3）, Embase（1980.1-2016.3）, Pubmed（1980.1-2016.3）,CBMdisc（1966.1-2016.3） and VIP（1978.1-2016.3）.Other internet databases were also searched to find trials according to the Cochrane Collaboration guidelines.Supplement literatures were also selected from the reference list of the included studies. High quality random-ized controlled trials（RCTs）and non-RCTs were selected. The software Rev Man 5.1 was used for the meta-analy-sis. Mean difference（MD） was used to assess the postoperative hemoglobin decline, total blood loss, length ofstay and volume of drainage. Odds ratio（OR） was used to evaluate the transfusion rate, risk of infectious andthromboembolism event.ResultsFive RCTs and five non-RCT met the inclusion criteria. There were signifi-cant differences in hemoglobin decline [（MD=-0.86, 95% CI：-1.32,-0.39, P=0.0003）], transfusion requirements[MD=-0.16, 95%CI（-0.24, 0.08）, P〈0.001]and total blood loss[MD=-303.12, 95%CI（-412.44, 193.80）,P〈0.00001] between TXA group and control group. There were no significant differences in length of stay, inci-dence of wound infection, deep vein thrombosis（DVT） and pulmonary embolism（PE） between treatment and con-trol groups.ConclusionThe present meta-analysis indicated that tranexamic acid could reduce hemoglobindecline, volume of drainage, total blood loss and transfusion requirements after TKA and was not related to theadverse reactions or complications such as wound infection, DVT and PE.