氨甲环酸减少全髋关节置换失血量Meta分析.docVIP

氨甲环酸减少全髋关节置换失血量的Meta分析 尹? 勇，马广文，黄? 斐，王? 清，吴云峰 安徽医科大学第四附属医院骨科，安徽省合肥市? 230022 A meta-analysis of tranexamic acid to reduce blood loss in total hip arthroplasty Yin Yong, Ma Guang-wen, Huang Fei, Wang Qing, Wu Yun-feng Department of Orthopedics, the Fourth Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China 摘要? 背景：氨甲环酸是一种赖氨酸合成衍生物，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，目前已在心血管外科治疗中广泛使用并证实可以有效减少手术失血量。目的：通过Meta分析对氨甲环酸在减少全髋关节置换失血量的有效性和安全性进行评价。方法：计算机检索数据库MEDLINE、PubMed、EMBASE、Cochrane Library、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)中关于氨甲环酸对全髋关节置换术失血量影响的随机对照研究，同时手检纳入文献的参考文献，检索时间截止到2013年9月。采用RevMan5.0软件进行统计学分析，氨甲环酸组与安慰剂组总失血量和总输血量采用加权均数差(WMD)评价，输血率、深静脉血栓发生率采用相对危险度(RR)评价。结果与结论：共纳入前瞻性随机对照研究16篇，样本总量884例。Meta分析结果显示，与安慰剂组相比，氨甲环酸能够减少全髋关节置换患者平均总失血量261.42 mL (95%CI -334.25至-188.59，P? 0.000 01)、平均减少置换中失血量135.04 mL (95%CI-223.31至-46.77,?P? 0.01)、平均减少置换后失血量 159.70 mL (95%CI -217.06 至 -102.34，P? 0.000 01), 氨甲环酸同时可以显著降低输血率(RR 0.46, 95%CI 0.36-0.59，P 0.000 01)，而两组间深静脉血栓发生率差异无显著性意义。说明静脉应用氨甲环酸能够显著减少全髋关节置换失血量，降低输血率，但不增加关节置换后深静脉血栓的发生率。 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 全文链接： 关键词?：?植入物；?人工假体；?肾移植；?氨甲环酸；?全髋关节置换；?失血；?输血；?Meta分析； ?? Abstract： BACKGROUND:?Tranexamic acid is a synthetic derivative of lysine, it can reversibly block the lysine binding sites on plasmin and plasminogen, thus playing anti-fibrinolytic effect. Tranexamic acid has been widely used in the treatment of cardiovascular surgery and is proven to effectively reduce blood loss.OBJECTIVE:?To evaluate the effectiveness and safety of tranexamic acid treatment on reducing blood loss in total hip arthroplasty through a meta-analysis.?METHODS:?An online retrieval of Medline, PubMed, EMBASE, Cochrane Library, CNKI and VIP databases before September 2013 was performed for screening randomized controlled trials about the effect of tranexamic acid on blood loss in total hip arthroplasty. Meanwhile the references of the included literatures were manually checked. Statistical analysis was p