全髋关节置换术后自体血回输有效性的Meta分析

Efficacy of postoperative blood retransfusion in total hip arthroplasty: a meta-analysis

目的对全髋关节置换术后自体血回输的效能进行系统评价和Meta分析。方法检索2000年1月1日至2017年10月31日Pubmed、Medline、Google scholar、Pro Quest Central、Cochrane Online Library和Web of Science数据库中,自体血回输应用于全髋关节置换术后的随机前瞻对照研究文献。采用改良Jadad法评估文献质量,应用Rev-Man5.1.7软件分析异体红细胞输注率和输注量。结果共纳入14篇文献,包括2 797例患者,不同国家的异体血输注指征不尽相同。与对照组相比,自体血回输技术可降低髋关节术后的异体输血率(RR:0.70,95%CI:0.59~0.82,P<0.0 001),并且可降异体输血量(WMD:-0.32,95%CI:-0.57^-0.06,P=0.01)。相关文献可能存在一定发表性偏倚。结论自体血回输技术可降低全髋关节置换术后异体红细胞输血率和输血量,但鉴于纳入文献的输血指征存在差异,且纳入文献存在一定异质性,有待今后发表大规模多中心的高质量临床研究后再次进行评价。

Objective To assess the efficacy of cell salvage to reduce RBC transfusion postoperatively in total hip arthroplasty by meta-analysis and systematic review. Methods Pubmed, Medline, Google scholar, ProQuest Central, Cochrane Online Library and Web of Science were searched from January 1 st 2000 to October 31 st 2017 for randomized clinical trials. RevMan 5.1.7 was used to analyze the allogeneic red blood cell transfusion rate and volume. Results Fourteen randomly controlled trials were involved, including 2 797 cases. The meta-analysis showed that, compared to the control group cell salvage could reduce the transfusion rate （RR：0.70, 95% Ch0.59 - 0.82, P 〈 0.0 001） and the transfusion vol- ume （WMD： - 0.32, 95% CR - 0.57- - 0.06, P = 0.01）. There was publishing bias among the literatures. Conclusion Cell salvage can reduce both the allogeneic RBC transfusion rate and transfusion volume. Multiple centers involved-RCTs are needed to draw a conclusion.