氨甲环酸减少胸腰椎后路融合围术期出血量的Meta分析

Tranexamic acid reduces perioperative blood loss in thoracolumbar posterior fusion: a meta-analysis

背景:有研究报道胸腰椎后路融合围术期运用氨甲环酸可减少围手术期出血量,但这些研究普遍病例数较少。因而,有必要对国内外氨甲环酸减少胸腰椎后路融合术后出血量的临床研究进行系统评价和分析。目的:探讨氨甲环酸减少胸腰椎后路融合围术期出血量的疗效和安全性。方法:计算机全面检索Cochrane Library,Pub Med,EMbase,Medline 4个外文数据库和在中国期刊全文数据库、中国生物医学文献、万方、维普等4个中文数据库中关于氨甲环酸在胸腰椎后路融合术中作用的随机对照研究,通过阅读全文对文献进行方法学质量评价,运用Rev Man 5.3软件进行异质性分析,再进行Meta分析合并效应量。结果与结论:共计纳入9个研究,其中氨甲环酸组患者363例,对照组341例,Meta分析结果显示:对比同等剂量安慰剂,在胸腰椎后路融合术中静滴氨甲环酸可降低术中出血量(MD=-50.57,95%CI:-78.69至-22.44),降低术后引流量(MD=-109.45,95%CI:-124.50至-94.39),减少围手术期输血需求(OR=0.51,95%CI:0.31-0.85),也降低了手术操作时间(MD=-6.28,95%CI:-12.01至-0.56),且并未增加深静脉血栓事件的发生率(OR=0.46,95%CI:0.10-2.06),氨甲环酸还可降低腰椎后路融合围手术期总出血量(MD=-184.53,95%CI:-224.66至-144.40)。结果证实,在胸腰椎后路融合术中静滴氨甲环酸可减少术中、术后出血量和输血,具有较好的疗效和安全性,由于纳入文章病例数不多,仍需大样本、多中心随机对照试验的进一步去证实。

BACKGROUND： Tranexamic acid has been reported to reduce perioperative blood loss in thoracolumbar posterior fusion, but these studies are small-sample trials. Therefore, it is necessary to systematically evaluate the studies at home and abroad addressing that tranexamic acid can reduce blood loss after thoracolumbar posterior fusion.OBJECTIVE： To investigate the effectiveness and safety of tranexamic acid for reducing the perioperative blood loss in thoracolumbar posterior fusion. METHODS： Databases of Cochrane Library, Pub Med, EMbase, Medline, CNKI, CBM, Wan Fang and VIP were searched to retrieve the randomized clinical trials concerning the effects of tranexamic acid in thoracolumbar posterior fusion. The quality of the studies was performed by two researchers, and meta-analysis was conducted using Rev Man 5.3 software. RESULTS AND CONCLUSION： Nine studies were enrolled, including 363 cases in tranexamic acid group and 341 cases in placebo group. Compared with the placebo group, venous injection of tranexamic acid after thoracolumbar posterior fusion, could significantly reduce the intraoperative blood loss（MD=-50.57, 95%CI：-78.69--22.44）, postoperative volume of drainage（MD=-109.45, 95%CI：-124.50--94.39）, perioperative blood transfusion（OR=0.51, 95%CI： 0.31-0.85）, and shorten the operation time（MD=-6.28, 95%CI：-12.01--0.56）. Additionally, tranexamic acid did not increase the incidence of deep venous thrombosis（OR=0.46, 95%CI： 0.10-2.06）. Tranexamic acid also could reduce the preoperative total blood loss（MD=-184.53, 95%CI：-224.66--144.40）. These results indicate that venous injection of tranexamic acid in thoracolumbar posterior fusion can reduce intraoperative, postoperative blood loss and blood transfusion, with a good effectiveness and safety. However, multi-center large-sample randomized controlled trials are required to support the argument, because of potential bias in the included studies.