中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (28): 4584-4592.doi: 10.3969/j.issn.2095-4344.1268

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    

氨甲环酸减少股骨转子间骨折术中及术后失血有效性和安全性的Meta分析

钟艳春，刘禄林，肖建华，欧阳训彦，黄为民，刘午阳   

  1. 赣南医学院第一附属医院骨科，江西省赣州市  341000
  • 出版日期:2019-10-08 发布日期:2019-10-08
  • 通讯作者: 刘午阳，硕士，教授，主任医师，赣南医学院第一附属医院骨科，江西省赣州市 341000
  • 作者简介:钟艳春，男，1986年生，汉族，江西省赣州市人，2012年南昌大学毕业，硕士，主治医师。
  • 基金资助:

    江西省科技厅计划项目(20122BBG70108)，项目负责人：刘午阳|江西省教育厅科技青年项目(GJJ170883)，项目负责人：钟艳春|江西省教育厅科技计划项目(GJJ14678)，项目负责人：刘午阳

postoperative blood loss of intertrochanteric fracture: a meta-analysis

Zhong Yanchun, Liu Lulin, Xiao Jianhua, Ouyang Xunyan, Huang Weimin, Liu Wuyang   

  1. Department of Orthopedics, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
  • Online:2019-10-08 Published:2019-10-08
  • Contact: Liu Wuyang, Master, Professor, Chief physician, Department of Orthopedics, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
  • About author:Zhong Yanchun, Master, Attending physician, Department of Orthopedics, the First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
  • Supported by:

    the Project of Science and Technology Department of Jiangxi Province, No. 2012BBG70108 (to LWY)| the Youth Program of Education Department of Jiangxi Province, No. GJJ170883 (to ZYC)| the Science and Technology Program of Education Department of Jiangxi Province, No. GJJ14678 (to LWY)

PDF

117

摘要：

文章快速阅读：


文题释义：
氨甲环酸：是一种广泛使用的纤溶酶抑制剂，通过竞争纤溶酶原上的赖氨酸位点，从而降低纤维蛋白与纤溶酶或纤溶酶原的结合能力，有效降低了其活性，目前已广泛用于关节外科、脊柱外科、心胸外科等领域，取得了良好的疗效。
股骨转子间骨折：是老年人常见的髋部骨折，多以手术固定方式治疗，但围术期失血量大，以隐性失血为主，术后输血率较高，并发症较多、死亡率较高。
 
摘要
背景：氨甲环酸在关节置换中已有广泛使用，既能减少围术期出血，又不会增加血栓风险。有研究报道氨甲环酸在股骨转子间骨折手术中使用也有相似的效果，但这些单个研究病例数较少，研究结果不一，尚存在争议。因而，有必要对国内外氨甲环酸减少股骨转子间骨折术中及术后失血的临床研究进行系统评价和分析。
目的：探讨氨甲环酸减少股骨转子间骨折术中及术后失血的有效性和安全性。
方法：通过计算机检索PubMed、Cochrane图书馆、EMbase和中国生物医学文献、中国知网、维普及万方7个数据库中关于氨甲环酸减少股骨转子间骨折术中及术后失血的随机对照试验和前瞻性队列研究，检索时限均从建库至 2018-10-05。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3 软件进行Meta分析。
结果与结论：共纳入13个研究，12个随机对照试验和1个前瞻性队列研究，包括1 353例股骨转子间骨折病例，其中氨甲环酸组病例676例，对照组677例。Meta分析结果显示：与对照组相比，氨甲环酸可降低股骨转子间骨折术中及术后总失血量(MD=-228.92，95%CI：-300.93至-156.91，P < 0.000 01)、术中出血量(MD=-23.74，95%CI：-40.91至-6.56，P=0.007)及术后隐性失血量(MD=-153.36，95%CI：-179.21至-127.50，P < 0.000 01)；提高术后血红蛋白浓度(MD=6.9，95%CI：5.44-8.44，P < 0.000 01)及红细胞压积(MD=1.44，95%CI：0.86-2.03，P < 0.000 01)，降低围术期输血率(OR=0.48，95%CI：0.36-0.63，P < 0.000 01)，且并未增加血栓风险D二聚体浓度(SMD=-0.13，95%CI：-0.58-0.32，P=0.57)及深静脉血栓事件的发生率(OR=1.41，95%CI：0.79-2.52，P=0.24)，也未影响手术时间(MD=-0.16，95%CI：-1.31-1.00，P=0.79)及术后死亡率(OR=1.61，95%CI：0.78-1.33，P=0.2)。结果提示：使用氨甲环酸减少股骨转子间骨折术中及术后失血是一种安全有效的方法，受纳入研究数量和质量的限制，上述结论尚待更多高质量、大样本、多中心随机对照试验进一步证实。


 ORCID: 0000-0001-6273-2125(钟艳春)

关键词: 氨甲环酸, 股骨转子间骨折, 随机对照试验, 前瞻性队列研究, 总失血量, 术中出血量, 输血, 血栓, Meta分析

Abstract:

BACKGROUND: Tranexamic acid has been widely used in joint arthroplasty, which not only reduces perioperative blood loss, but also does not increase the risk of venous thrombus. It is reported that the use of tranexamic acid in the surgery of intertrochanteric fractures has similar effects. However, these studies are small-sample trials, and the results are still controversial. It is necessary to systematically evaluate and analyze the clinical researches about the tranexamic acid on reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
OBJECTIVE: To investigate the effectiveness and safety of tranexamic acid for reducing the intraoperative and postoperative blood loss of intertrochanteric fracture.
METHODS: PubMed, Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang databases were searched for the randomized controlled trials and prospective cohort studies addressing tranexamic acid reducing intraoperative and postoperative blood loss of intertrochanteric fracture from inception to October 5, 2018. The literature selection, data extraction, and evaluation of bias risk of the studies were performed independently by two authors. Meta-analysis was conducted using RevMan 5.3 software.
RESULTS AND CONCLUSION: Thirteen studies were enrolled, including 12 randomized controlled trials and 1 prospective cohort, involving 1 353 cases of intertrochanteric fracture (676 in tranexamic acid group, and 677 in placebo group). Meta-analysis results showed that compared with the placebo group, tranexamic acid applied in the surgery of intertrochanteric fractures, could significantly reduce the intraoperative and postoperative total blood loss (MD=-228.92, 95%CI: -300.93 to -156.91, P < 0.000 01), intraoperative blood loss (MD=-23.74, 95%CI: -40.91 to -6.56, P=0.007), the hidden blood loss (MD=-153.36, 95%CI: -179.21 to -127.50, P < 0.000 01) and increase the postoperative hemoglobin (MD=6.9, 95%CI: 5.44 to 8.44, P < 0.000 01), hematocrit levels (MD=1.44, 95%CI: 0.86 to 2.03, P < 0.00001) and reduce the postoperative blood transfusion rate (OR=0.48, 95%CI: 0.36 to 0.63, P < 0.000 01). Additionally, tranexamic acid did not increase the postoperative D-dimer levels (SMD=-0.13, 95%CI: -0.58 to 0.32, P=0.57), or the incidence of venous thrombosis (OR=1.41, 95%CI: 0.79 to 2.52, P=0.24). Tranexamic acid made no effect on the operation time (MD=-0.16, 95% CI: -1.31 to 1.00, P=0.79) and postoperative mortality (OR=1.61, 95%CI: 0.78 to 1.33, P=0.2). These results indicate that it is safe and effective to use tranexamic acid for reducing intraoperative and postoperative blood loss of intertrochanteric fracture. However, multi-center large-sample randomized controlled trials are required to confirm the conclusions, because of limitations in study counts and quality.

Key words: tranexamic acid, intertrochanteric fracture, randomized controlled trials, prospective cohort study, total blood loss, intraoperative blood loss, blood transfusion, venous thrombosis, meta-analysis

中图分类号: