控制性降压在全髋、膝关节置换术中有效性和安全性的Meta分析

Efficacy and safety of controlled hypotension for total hip or knee replacement: a meta-analysis

目的系统评价控制性降压在全髋、膝关节置换术中的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data和CBM数据库,搜集关于控制性降压在全髋、膝关节置换术中的随机对照试验(RCT),检索时限均从建库至2019年9月。由2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软件进行Meta分析。结果共纳入15个RCT,包括854例患者。Meta分析结果显示:与术中不采用控制性降压相比,采用控制性降压能明显减少术中出血量[MD=−267.35,95%CI(−314.54,−220.16),P<0.00001]、减少异体输血量[MD=−292.84,95%CI(−384.95,−200.73),P<0.00001],降低术后24 h简易智力状态检查(MMSE)评分[MD=−1.08,95%CI(−1.82,−0.34),P=0.004],但两组在术后96 h MMSE评分[MD=−0.11,95%CI(−0.50,0.28),P=0.57]和术中尿量[MD=57.93,95%CI(−152.57,268.44),P=0.59]差异均无统计学意义。结论现有证据表明,在全髋、膝关节置换术中使用控制性降压能减少术中出血量和异体输血量,对维持重要脏器血流灌注没有明显影响;对术后认知功能会造成一定影响,短期内可恢复。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证。

Objectives To systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.Methods PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data and CBM databases were electronically searched to collect randomized controlled trials(RCTs)on controlled hypotension for total hip or knee replacement from inception to September 2019.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by RevMan 5.3 software.Results A total of 15 RCTs involving 854 patients were included.The results of meta-analysis showed that compared with no controlled hypotension during surgery,controlled hypotension could reduce intraoperative blood loss(MD=−267.35,95%CI−314.54 to−220.16,P<0.00001),allogeneic blood transfusion(MD=−292.84,95%CI−384.95 to−200.73,P<0.00001),and 24 h postoperative mini-mental state examination(MMSE)score(MD=−1.08,95%CI−1.82 to−0.34,P=0.004).However,there were no significant differences in 96 h postoperative MMSE score(MD=−0.11,95%CI−0.50 to 0.28,P=0.57)and intraoperative urine volume(MD=57.93,95%CI−152.57 to 268.44,P=0.59).Conclusions The current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion.Furthermore,there is no obvious effect on the maintenance of blood perfusion in important organs,despite certain effects on the postoperative cognitive function,which can be recovered in short term.Due to limited quality and quantity of the included studies,more high quality studies are required to verify above conclusions.