氨甲环酸减少全膝关节置换术失血量的Meta分析

目的 通过Meta分析评价抗纤溶药物氨甲环酸(tranexamic acid,TXA)对全膝关节置换术失血量的影响.方法 计算机检索数据库MEDLINE(1966年至2008年8月)、PubMed(1966年至2008年8月)、EMBASE(1966年至2008年8月)、Cochrane图书馆(2008年第3期)、中国生物医学光盘数据库(1978年至2008年8月)、中国生物医学文献数据库(1978年至2008年8月)和维普中文科技期刊数据库(1978年至2008年8月)中关于TXA减少全膝关节置换术出血量的临床随机对照研究,并查阅所有检出文献和相关综述的参考文献作为补充资料,截止到2008年8月.采用RevMan 4.3软件进行统计分析,TXA组与安慰剂组总失血量和输血单位采用加权均数差评价,输血率、深静脉血栓和肺栓塞症发生率采用优势比评价.结果 共纳入前瞻性随机对照研究8篇.Meta分析结果显示,与安慰剂组比较TXA能够减少全膝关节置换患者总出血量(加权均数差值-542.11,95%置信区间[-723.20,-361.01],P<0.001)和输血单位(加权均数差值-1.33,95%置倩区间[-1.70,-0.97],P<0.001),降低输血率(优势比0.11,95%置信区间[0.06,0.18],P<0.001),而深静脉血栓和肺栓塞症发生率差异无统计学意义.结论 静脉注射TXA能够减少全膝关节置换手术失血量和输血单位,降低输血率,不增加深静脉血栓和肺栓塞症的发生风险.

A meta-analysis of Tranexamic acid to reduce blood loss in total knee arthroplasty

Objective To assess the effectiveness and safety of using Tranexamic acid (TXA) in reducing blood loss in total knee arthroplasty (TKA). Methods Studies were identified by computer from the Coehrane Central Register of Controlled Trials (Central, 2008, Issue 3), MEDLINE (1966 to August 2008), EMBASE (1966 to August 2008), CBM (1978 to August 2008) and VIP(1978 to August 2008), Rele-vant journals or conference proceedings were also searched manually. The authors only enrolled high quality (Jadad score ≥ 3) randomized controlled trials (RCTs). Two independent reviewers searehed and assessed the titles. Weighted mean differenee (WMD) of blood loss, odds ratio (OR) of transfusion, deep vein thrombosis (DVT) and pulmonary embolism (PE) rate in TXA-treated group versus placebo group were ealeulated across studies. Results Eight RCTs met the criteria for recta-analysis. The use of TXA significantly reduced total blood loss (WMD=-542.11, 95%CI [-723.20, -361.01], P<0.001), transfusion unit (WMD=-1.33, 95%CI [-1.70, -0.97], P<0.001) and proportion of patients requiring blood transfusion (OR =0.11, 95% CI[0.06,0.18], P<0.001), without rising the risk of DVT and PE compared with placebo group. Conclusion This meta-analysis indicates that the use of TXA for patients undergoing TKA is effective and safe in reducing to-tal blood loss and the requirement of blood transfusion.