全膝关节置换术中口服氨甲环酸疗效与安全性的Meta分析

Curative effect and safety of oral tranexamic acid in total knee arthroplasty:a meta analysis

目的通过Meta分析研究全膝关节置换术中口服氨甲环酸的疗效与安全性。方法检索Cochrane图书馆、PubMed、EMbase、中国生物医学文献数据库、中国知网、维普数据库和万方数据知识服务平台,收集比较口服氨甲环酸组与空白对照组的随机对照试验,采用RevMan 5.3.5软件进行Meta分析,比较两组间术后血红蛋白(Hb)下降幅度、输血率及深静脉血栓栓塞症发生率。结果共纳入5篇随机对照研究,包括608例患者。Meta分析结果显示:口服氨甲环酸组术后Hb下降幅度低于空白对照组[加权均数差(WMD)=-6.03,95%CI(-9.54,-2.52),P=0.000 8];口服氨甲环酸组术后输血率低于空白对照组[OR=0.33,95%CI(0.19,0.58),P=0.000 1];两组术后深静脉血栓相关并发症发生率差异无统计学意义[OR=1.30,95%CI(0.25,6.77),P=0.75]。结论全膝关节置换术中口服氨甲环酸安全有效,可减少术后Hb下降幅度及术后输血率,且不增加深静脉血栓栓塞症的发生。

Objective To analyze the effectiveness of oral tranexamic acid in total knee arthroplasty.Methods The randomized controlled trials（RCTs）of the comparison between oral tranexamic acid group and blank control group were collected by retrieving from the Cochrane Library,PubMed,Embase,CNKI,VIP Data and Wangfang Data.The meta analysis was performed by adopting the RevMan 5.3 software.The Hb descend range,blood transfusion rate and occurrence rate of deep vein thromboembolism were compared between the two groups.Results Five RCTs were included,involving 608 patients.The meta analysis results showed that the postoperative Hb descend range in the oral tranexamic acid group was lower than that in the blank control group[WMD=-6.03,95%CI（-9.54,-2.52）,P=0.000 8]and the postoperative blood transfusion rate in the oral tranexamic acid group was lower than that in the blank control group[OR=0.33,95%CI（0.19,0.58）,P=0.000 1];the occurrence rate of deep vein thrombosis related complications had no statistical difference the between two groups[OR=1.30,95%CI（0.25,6.77）,P=0.75].Conclusion Oral tranexamic acid in TKA is safe and effective,and could reduce postoperative Hb descend range without increasing the occurrence of deep vein thromboembolism.