氨甲环酸对脊柱手术围术期作用的系统评价和Meta分析

Effects of tranexamic acid for spinal surgery during perioperative period：a systematic review and Meta-analysis

目的评价氨甲环酸对脊柱手术围术期的作用及其安全性。方法检索1999年3月-2017年3月Ovid、PubMed、sciencedirect、中国知网、维普、万方等数据库，根据纳入和排除标准。最后检索出氨甲环酸在脊柱手术中应用的高质量（Jadad评分≥3分）前瞻性随机对照研究文献8篇。提取数据，采用RevMan5．0软件进行Meta分析，分析氨甲环酸在脊柱手术术中及术后对出血量、输血率、活化部分凝血活酶时间（APTT）、红细胞压积（Hct）、血红蛋白（Hb）及血栓并发症发生率的影响。结果围术期静脉给予氨甲环酸可以显著减少脊柱手术术中失血量（SMD=-0.33，95％CI-0．12，-0．54，P〈0．01）、术后输血率（OR=0．55，95％CI 0．37，0．82，P〈0．01）。氨甲环酸组与对照组比较，术后24hAPTF降低（MD=1．45，95％CI-2．92，0．01，P〉0．05），术后Hct增加（MD=1．55，95％C／0．45，2．65，P〈0．01），术后Hb增加（MD=0．49，95％C／0．20，2．65，P〈0．01）。两组血栓并发症发生率差异无统计学意义（OR=1．01，95％CI 0．06，16．52，P〉0．05）。结论氨甲环酸能有效减少脊柱手术的失血量、降低输血率，且并未增加术后深静脉血栓、肺栓塞的发生率。

Objective To assess the effect and safety of tranexamic acid used in spinal surgery by means of a systematic review and Meta-analysis. Methods Literatures were retrieved from Ovid （1999 March to 2017 March）, PubMed （1999 March to 2017 March）, Sciencedirect（1999 March to 2017 March）, CNKI, VIP and Wangfang. All the related literatures were checked on the selection criters. Only the retrospective randomized controlled trails （RCTs） with high quality （Jadad score/〉 3 ） and with double-blind process were enrolled. The relevant data were analyzed using RevMan 5.0 to compare about difference of intraoperative and postoperative blood loss, transfusion rate, postoperative activated partial thromboplastin time （AI：q＇T）, postoperative hematocrit （Hct）, postoperative hemoglobin （Hb） and thrombotic complications between tranexamic acid group and placebo group. Results Only 8 high quality RCTs met the inclusion criteria. The use of tranexamic acid in spinal surgery significantly reduced the intraoperative blood loss （SMD = -0.33,95% CI- 0. 12,0.54, P 〈 0.01 ）, and reduced the rate of transfusion（ OR = O. 55,95% CI 0. 37,0.82, P 〈 0.01 ）. TXA group had a significant decrease of APTT at 24 h after surgery （MD = 1.45,95 % CI - 2.92,0.01, P 〉 0.05 ）, a significant increase of post-operative Hct （MD = 1.55, 95% CI 0.45,2.65, P 〈 0.01 ） and an enhancement of Hb （ MD = 0.49,95% CI 0. 20,2.65, P 〈0.01 ） compared with placebo group. The difference of thrombotic complication rates risks between tranexamic acid group and placebo group was not statistically significant（ OR = 1.01, 95% CI0.06,16.52, P〉0.05）. Conclusion The use of tranexamic acid can significantly reduce intraoperative blood loss and the rate of transfusion during spinal surgery, without increase of postoperative deep vein thrombosis or pulmonary embolism.