成分输血对难治性妇产科大出血病人凝血功能影响的Meta分析

Meta analysis of the effect of component blood transfusion on coagulation function in refractory obstetric and gynecological patients with massive hemorrhage

目的检索国内关于成分输血应用于难治性妇产科大出血病例的文献,总结凝血指标变化的对比结果,为妇产科临床成分输血的应用提供循证医学依据。方法制定文献的纳入标准、排除标准及检索策略,检索维普中文科技期刊全文数据库、万方医学数据库、中国知网和中国生物医学文献数据库(CBM),提取有关成分输血应用于难治性妇产科大出血病例的文献,评价纳入研究的文献质量,并提取有效数据后采用RevMan 5.3软件进行Meta分析。结果纳入研究的8篇文献,共报道445例,其中成分输血组244例;常规输血组201例。Meta分析结果显示:输血后两组血小板(PLT)检验结果比较的综合检验结果为Z=9.70,加权均数差(MD)值11.24(8.97~13.51),P<0.00001,差异有统计学意义;凝血酶原时间(PT)的综合检验结果为Z=6.80,加权均数差(MD)值-2.62(-3.38^-1.87),P<0.00001,差异有统计学意义;活化部分凝血活酶时间(APTT)的综合检验结果为Z=5.21,加权均数差(MD)值-4.04(-5.56^-2.52),P<0.00001,差异有统计学意义。结论有方案计划的成分输血,应用于妇产科大出血凝血功能紊乱的病人临床疗效确切,且无明显不良反应。

To retrieve the domestic literature on the application of blood component transfusion in the treatment of patients with refractory gynecologic and obstetric hemorrhage, summarize the comparison results of coagulation indexes and provide the basis of evidencebased medicine for the application of blood transfusion in obstetrics and gynecology. Methods We formulated the inclusion criteria and exclusion criteria and searched literatures in VIP database, Wanfang database, CNKI and CBM. The literature on the application of blood transfusion in the treatment of refractory obstetrics and Gynecology hemorrhage were evaluated and analyzed with RevMan 5.3 software .Results 8 literature and 445 cases on the application of blood transfusion in the treatment of refractory obstetrics and Gynecology hemorrhage included and were reported including 244 cases （group A） with component blood transfusion and 201 cases with routine blood transfusion （group B）. After blood transfusion, the two groups ’comprehensive test results of PLT with Z=9.70 and the MD value was 11.24 （8.97～13.51）（P〈0.00001）. The two groups ’comprehensive test results of PT was Z=6.80 and MD value was2.62 （3.38～1.87） （P〈0.00001）. The two groups ’comprehensive test results of APTT was Z=5.21 and MD value was4.04 （5.56～2.52） （P〈0.00001）.Conclusion Planned component blood transfusion used in obstetrics and gynecology bleeding patients with coagulation disorders has the definite curative effect and no obvious adverse reactions.