口服与静脉注射氨甲环酸治疗全膝及全髋关节置换后出血的Meta分析

文题释义：氨甲环酸：是一种抑制纤溶酶原激活的抗纤溶药物，它可以可逆性的阻断纤溶酶和纤溶酶原上赖氨酸结合点从而发挥抗纤维蛋白溶解作用，与赖氨酸结合点从而发挥抗纤维蛋白溶解作用。 Meta分析：是循证医学重要的研究方法和最佳证据来源之一，是临床科研工作者必备的研究方法和技术。应用统计学概念及方法收集整理与分析针对于某个概念，找出相关变量的关系进行比较计算，弥补一般文献综述的研究不足。 背景：接受全膝关节或全髋关节置换的患者可用氨甲环酸减少出血量，氨甲环酸有多种给药方式，目前对于氨甲环酸的最佳使用途径仍然存在较大争议。 目的：对比评价口服与静脉注射氨甲环酸治疗全膝关节及全髋关节置换后出血的疗效及安全性。 方法：全面检索PubMed、Cochrane Library、Embase、Web of Science等数据库，检索时限为各数据库建库时间至2019年5月，收集以口服及静脉应用氨甲环酸减少全膝或全髋关节置换术后出血的临床随机对照试验，提取资料并进行方法学质量评估。采用Revman 5.3对纳入结果进行Meta分析。 结果与结论：①9篇文献纳入研究，共1 080例患者；②Meta分析结果显示，口服与静脉注射氨甲环酸术后总失血量差异无显著性意义MD=1.43，95%CI(-40.02-42.88)，P=0.95]，术后血红蛋白减少量差异无显著性意义MD=-0.03，95%CI(-0.11-0.05)，P=0.45]；③口服与静脉注射氨甲环酸术后输血率差异无显著性意义RR=0.91，95%CI(0.55-1.49)，P=0.70]，术后深静脉血栓发生率差异无显著性意义RR=0.43，95%CI(0.11-1.64)，P =0.22]，术后住院时间差异无显著性意义MD=0.00，95%CI(-0.03-0.03)，P=0.93]；④结果表明，口服与静脉注射氨甲环酸有着类似的功效和临床价值。但是由于纳入文献量较少且质量有限，尚需方法科学的大样本、多中心、高质量临床随机对照试验来进行进一步验证。 ORCID: 0000-0003-3987-4904(林杰彬) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Meta-analysis of efficacy of oral versus intravenous tranexamic acid in reducing blood loss after total knee and hip arthroplasties

BACKGROUND:Tranexamic acid can effectively reduce the blood loss of total knee or hip arthroplasties.Tranexamic acid can be administered in a variety of ways;however,there is still much controversy about the best use of tranexamic acid.OBJECTIVE:To compare the efficacy and safety between oral and intravenous tranexamic acid for blood loss after total knee and hip arthroplasties.METHODS: Randomized controlled trials concerning oral tranexamic acid and intravenous tranexamic acid for reducing blood loss after totalknee and hip arthroplasties were retrieved from PubMed, Cochrane Library, Embase and Web of Science databases from inception to May2019. The data were extracted for the methodological quality. Then meta-analysis was conducted by Revman 5.3 software.RESULTS AND CONCLUSION: Nine randomized controlled trials involving 1 080 cases were included. The results of this meta-analysisshowed that there were no significant differences in total blood loss MD=1.43, 95%CI(-40.02-42.88), P=0.95], postoperative hemoglobindecline MD=-0.03, 95%CI(-0.11-0.05), P=0.45], transfusion rate RR=0.91, 95%CI(0.55-1.49), P=0.70], deep vein thrombosis rateRR=0.43,95%CI(0.11-1.64), P=0.22], or hospitalization time MD=0.00, 95%CI(-0.03-0.03), P=0.93] between two groups. These results indicate thatoral tranexamic acid shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasties. However, due to thelow number and limited quality of included studies, more randomized controlled trials with large samples should be rigorously designed toverify the conclusion.