肝移植术中应用氨甲环酸对于术中出血的影响

Application of tranexamic acid on effects of intraoperative hemorrhage in liver transplantation

目的系统评价氨甲环酸在肝移植手术中血液保护方面的有效性和安全性。方法计算机检索Cochrane图书馆、MEDLINE、CNKI、VIP、CBM(均从建库至2017年5月),收集所有氨甲环酸用于肝移植手术的随机对照试验。使用Cochrane系统评价方法对纳入研究进行质量评价后,采用Rev Man 5.3软件进行Meta分析。结果 1)4篇文献比较了术后出血量,各研究间均存在统计学异质性(I2=94%,P<0.05),氨甲环酸与安慰剂相比,能减少术出血量[SMD=-1.95,95%CI(-3.21,-0.69)],P<0.05]。2)4篇文献报道了输注红细胞量,结果显示氨甲环酸能减少术中输注红细胞的量[SMD=-0.43,95%CI(-0.74,-0.11)],P<0.05];3篇文献报道了比较了术中血浆输注量,1篇文献报道了安慰剂组比氨甲环酸组术中血小板输注情况,结果表明氨甲环酸不能减少术中输注血浆和血小板的量。氨甲环酸与安慰剂以及其他抗纤溶药术后再次手术、术后出血、肾功能不全、血栓、感染、死亡其他不良事件发生率等不良事件发生率不增加。结论氨甲环酸可减少术中出血量及红细胞输入量,是1种安全有效的抗纤溶止血药物,限于纳入研究方法学质量上的局限性,本系统评价结果尚需更多高质量的随机对照试验进一步验证。

Objective To evaluate the efficacy and safety of tranexamic acid in blood protection in liver transplantation. Methods We searched the Cochrane library, MEDLINE, CNKI, VIP, CBM （from inception to May 2017）, to collect all the randomized controlled trials of tranexamic acid for liver transplantation, the quality of the included studies was evaluated, and meta-analyses were performed with Cochrane Collaboration＇s RevMan 5. 3 software. Results 1） A total of 8 studies involving 1107 patients were included, the results of meta-analyses showed： Compared with placebo, tranexamic acid was effective in reducing postoperative blood loss [ SMD= -1.95, 95%CI （ -3.21, -0. 69） ], P〈0. 05], there were statistical heterogeneity between the studies （12= 94%, P〈0. 05）, 2）Tranexamic acid was effective in reducing postoperative transfusion rates of RBC during the operation [ SMD = -0. 43, 95% CI （ -0. 74, -0. 11 ） ], P〈0. 05 ] ; however, less effective than the placebo in terms of reducing postoperative FFP and PLT transfusion. Compared with placebo and other antifibrinolitic drugs the bleeding, renal insufficiency, thrombosis, infection, death and the incidence of other adverse events were not increased in tranexamic acid group after surgery. Conclusion Tranexamic acid was a safe and effective antifibrinolitic drug in liver transplantation, for it can reduce the amount of bleeding and red blood cell transfusion, However, due to the limited quality of the included studies, further verification with more high quality trials was needed.