氨甲环酸对创伤性脑损伤治疗效果的Meta分析

Therapeutic effect of tranexamic acid on traumatic brain injury:A Meta-analysis

目的 本文对氨甲环酸(tranexamic acid,TXA)治疗创伤性脑损伤(traumatic brain injury,TBI)的随机对照试验(randomized controlled trial,RCT)进行系统综述和荟萃分析,探讨TXA治疗创伤性脑损伤的优缺点,以指导临床应用。方法 以Pubmed、CNKI和EMBASE作为搜索数据库。检索范围为每个数据库中发表的与本研究相关的所有论文,纳入的RCT在检索后需要进行筛选及方法学和质量评估。当I^(2)>50时,使用随机效应模型来评估死亡率。P<0.05视为差异有统计学意义。结果 经过初始检索得到160个试验,其中有9个试验涉及5 794例患者符合本次研究纳入标准。发现注射TXA可抑制脑出血范围的扩大(RR=0.93;95%CI=0.88~0.99;P=0.02);创伤后3 h内注射TXA的死亡率显著降低(RR=0.99;95%CI=0.98~1.00;P=0.03)。结论 本研究显示,TXA对创伤性脑损伤患者脑出血范围的扩大有抑制作用。创伤后注射TXA的时间较早,死亡率就越低。TXA也可降低神经外科手术的可能性,但在改善格拉斯哥昏迷评分和减少住院时间方面无明显意义。

Objective This paper conducted a systematic review and meta-analysis of a randomized controlled trial(RCT) of tranexamic acid(TXA) for traumatic brain injury(TBI) to explore the advantages and disadvantages of TXA to guide its clinical application.Methods Pubmed,CNKI,and EMBASE were used as the search databases.The search covered all papers published in each database,and the included RCT required screening and methodological and quality assessment after the search.A random effects model was used to assess mortality when I^(2)> 50.P<0.05 was considered as a statistically significant difference.Results The initial search yielded 160 trials,of which 9 trials involved 5,794 patients who met our inclusion criteria.We found that TXA injection inhibited the expansion of ICH(RR=0.93,95% CI=0.88~0.99,P=0.02),mortality from TXA within3 hours after trauma(RR=0.99,95%CI=0.98~1.00,P=0.03).Conclusion This study showed that TXA has an inhibitory effect on the expansion of cerebral hemorrhage range in TBI patients.TXA injection earlier after trauma caused the lower mortality.TXA also reduced the likelihood of neuro-surgery,but was not significant in improving glasgow coma scores and reducing hospital stay.