氨甲环酸静脉联合局部应用在初次全髋关节置换中疗效及安全性的Meta分析

摘要

BACKGROUND:In the total hip arthroplasty, intravenous and topical tranexamic acid can significantly reduce the perioperative blood loss and blood transfusion rate, but at present, the clinical application of tranexamic acid is stil controversial. OBJECTIVE:Cochrane system evaluation method is applied on the efficacy and safety of intravenous combined with topical application versus single-dose intravenous application of tranexamic acid in the total hip arthroplasty. METHODS:We searched the Cochrane Library, PubMed, Ovid, EMBASE, CBM, Wanfang, VIP and CNKI database, from inception to July 2016 and retrieval of randomized control ed trials concerning intravenous combined with topical application and single dose intravenous application of tranexamic acid during total hip arthroplasty. Total blood loss, intraoperative blood loss, postoperative blood loss, blood transfusion rate, thrombosis, operation time, and length of hospital stay were analyzed by meta-analysis. RESULTS AND CONCLUSION:(1) There were seven randomized control ed trials with 620 patients. (2) Meta-analysis results indicated that total blood loss, intraoperative blood loss, postoperative blood loss, and blood transfusion rate were significantly better in the combination group than in the single dose group (P<0.05). There were no significant differences in thrombosis, operation time, and length of hospital stay between the two methods (P>0.05). (3) These results suggested that compared with the single dose of intravenous application, intravenous combined with topical application, can significantly reduce the loss of blood volume and blood transfusion rate and did not increase the rate of thrombosis. Subject headings:Arthroplasty, Replacement, Hip;Tranexamic Acid;Venous Thrombosis;Hemorrhage;Tissue Engineering%背景：在全髋关节置换术中，静脉与局部应用氨甲环酸可显著减少围手术期的失血量和输血率，但目前在临床工作中对氨甲环酸的应用方式仍有争议。　　目的：应用 Cochrane系统方法评价氨甲环酸静脉联合局部用药与单剂量静脉用药在全髋关节置换术中的应用效果及安全性。　　方法：计算机检索Cochrane Library，PubMed，Ovid，EMBASE，CBM，万方，VIP，CNKI等数据库，检索时间从建库至2016年7月，检索有关全髋关节置换术中氨甲环酸静脉联合局部与单剂量静脉应用的随机对照试验文献，对2种用药方式的总失血量、术中失血量、术后失血量、输血率、血栓形成、手术时间、住院时间进行Meta分析。　　结果与结论：①共纳入7篇随机对照试验，包含620例患者；②Meta分析结果显示，静脉联合局部组在总失血量、术中失血量、术后出血量少、输血率方面较单剂量静脉用药组有明显优势(P<0.05)，在血栓形成、手术时间、住院时间2组差异无显著性意义(P>0.05)；③结果表明，与单剂量静脉用药相比，在全髋关节置换术中氨甲环酸静脉联合局部应用可明显减少失血量及输血率，但不增加血栓形成率。