氨甲环酸用于非体外循环冠状动脉搭桥术血液保护作用的Meta分析

目的采用系统回顾和Meta分析评价氨甲环酸用于非体外循环冠状动脉搭桥术（OPCAB）的血液保护效果及安全性。方法全面检索Pubmed、Cochrane CENTRAL、EMBASE数据库，将行OPCAB术患者，分为氯甲环酸组和对照组进行比较，报道了至少一项明确临床结果的所有随机临床试验均纳入本Meta分析，日期截止至2012年1月。使用Review Manager 5．1统计学软件行Meta分析，计数资料计算优势比（OR）和95％可信区间（CI），连续变量计算加权均数差（WMD）和95％CI。结果共10项随机临床试验中的849例病人纳入该Meta分析。在OPCAB术中，同对照组相比，氨甲环酸可明显减少病人24h的胸腔引流量（WMD-209ml，95％CI：-310ml--107ml，p〈0．001），并显著降低异体红细胞（OR 0．46，95％CI：0．33～0．63，p〈0．001）和新鲜冰冻血浆（OR 0．30，95％CI：018～0．51，p〈0．001）的使用率。两组病人术后严重栓塞并发症（包括急性心肌梗死、中风和肺栓塞）和肾功能衰竭的发生率，以及ICU停留时间、住院时间均无显著差别。结论现有证据表明OPCAB术应用氨甲坏酸可减少术后出血量，减低异体血使用率，有明确的血液保护作用。

The Blood Preservation Effect of Tranexamic Acid in Off-pump Coronary Bypass Graft Surgery: A Meta-analysis

Objective To determine the blood preservation efficacy and safety oftranexamic acid for off-pump coronary bypass graft （OPCAB） surgery by systematic review and meta-analysis. Methods A comprehensive search was undertaken to identify all randomized trials of tranexamic acid in OPCAB surgery. Pubmed, Cochrane CENTRAL and EMBASE databases were searched up to January 2012. All randomized trials comparing tranexamic acid and placebo in OPCAB surgery and reporting at least one predefined clinical outcome were included. Meta-analysis was conducted using the Cochrane Collaboration＇ s Revman 5.1 software. The odd radio （OR and confidence intervals CI]） and weighted mean differences （WMD, 95% CI） were calculated for dichotomous and continuous vaviables, respectively. Results Ten randomized trials involving 849 patients were included in the meta-analysis. During OPCAB surgery, the use of tranexamic acid significantly decreased the 24h chest-tube drainage （WMD -209ml, 95%CI ： -310ml- -107ml, p〈0.001） and reduced the transfusion rate of allogeneic red blood cells （OR 0.46, 95%CI ： 0.33 - 0.63, p〈0.001） and fresh frozen plasma （OR 0.30, 95%CI ： 0.18 -0.51, p〈 0.001）. There was no difference in severe thromboembolic complications （myocardial infarction, stroke and pulmonary embolism） and renal failure, ICU stay and hospital stay between tranexamic acid and placebo groups. Conclusions Current evidence suggests that tranexamic acid reduces the blood loss and the exposure to aUogeneic blood products in OPCAB surgery, has blood conservation effect.