氨甲环酸口服与静脉应用在全膝髋关节置换围手术期有效性及安全性的Meta分析

Efficacy and Safety of Oral versus Intravenous Tranexamic Acid in Primary Total Knee and Hip Arthroplasty: a Meta-analysis

目的:通过Meta分析研究全膝髋关节置换术中口服氨甲环酸的疗效与安全性。方法:计算机检索PubMed、the Cochrane Library、Medline、Embase、Web of Science、SinoMed、CNKI和WanFang Data数据库,搜集比较行全膝髋关节置换术患者口服氨甲环酸与静脉应用氨甲环酸的随机对照试验(randomized controlled trials,RCTs)或非随机对照试验(non-randomized controlled trials,non-RCTs),检索时限均从建库至2019年4月,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3.5软件进行Meta分析。结果:共纳入5个RCTs及2个non-RCTs,共3 652例患者。Meta分析结果显示,口服氨甲环酸组术后Hb下降幅度(mg·ml^-1)[WMD=0.15,95%CI(0.05,0.26),P=0.004]及总失血量(ml)[WMD=84.73,95%CI(34.01,135.44),P=0.001]均高于静脉应用氨甲环酸组;口服氨甲环酸组术后输血率[RR=0.74,95%CI(0.49,1.12),P=0.16]及深静脉血栓并发症发生率[OR=0.79,95%CI(0.32,1.94),P=0.60]与静脉应用氨甲环酸组的差异无统计学意义。结论:骨科关节置换术患者口服应用氨甲环酸与静脉应用氨甲环酸均可减少术后输血率,且不增加深静脉血栓栓塞症的发生。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective: To analyze the effectiveness of oral tranexamic acid in total knee and hip arthroplasty. Methods: PubMed, the Cochrane Library, Medline, Embase,Web of Science, SinoMed, CNKI and Wanfang Data were electronically searched to collect randomized controlled trials ( RCTs) and non-RCTs of oral versus intravenous tranexamic acid in total knee and hip arthroplasty from inception to April,2019. Two researchers independently screened literature , extracted data and assessed the risk of bias of included studies, then, Mela-analysis was performed by RerMan 5. 3.5 software. Results:5 RCTs and 2 non-RCTs involving 3 652 patients were included. The results of Meta-analysis showed that the postoperative hemoglobin decline (mg·ml^-1)( WMD=0.15, 95%CI 0.05 to 0.26, P=0. 004) and total blood loss (ml)( WMD=84.73,95%CI 34.01 to 135.44, P=0.001) in the oral tranexamic acid group were higher than that in the intravenous tranexamic acid group, and there were no significant differences regarding transfusion rate ( RR= 0. 74, 95%CI 0.49to 1.12, P=0. 16), or the occurence rate of deep vein thrombosis related complication ( OR=0.79, 95%CI 0.32 to 1.94, P=0.60) between the two groups. Conclusion :Oral tranexamic acid shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasty. Due to limited quality and quantity of the included studies,more high quality studies are needed to verify above conclusion.