中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
17期
2752-2757
,共6页
尹勇%马广文%黄斐%王清%吴云峰
尹勇%馬廣文%黃斐%王清%吳雲峰
윤용%마엄문%황비%왕청%오운봉
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
植入物%人工假體%腎移植%氨甲環痠%全髖關節置換%失血%輸血%Meta分析
식입물%인공가체%신이식%안갑배산%전관관절치환%실혈%수혈%Meta분석
tranexamic acid%arthroplasty,replacement,hip
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。
<br> 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。
<br> 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。
<br> 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<0.00001)、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 <0.00001),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<0.00001)，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。
揹景：氨甲環痠是一種賴氨痠閤成衍生物，它可以可逆性的阻斷纖溶酶和纖溶酶原上賴氨痠結閤點從而髮揮抗纖維蛋白溶解作用，目前已在心血管外科治療中廣汎使用併證實可以有效減少手術失血量。
<br> 目的：通過Meta分析對氨甲環痠在減少全髖關節置換失血量的有效性和安全性進行評價。
<br> 方法：計算機檢索數據庫MEDLINE、PubMed、EMBASE、Cochrane Library、中國期刊全文數據庫(CNKI)、維普中文科技期刊數據庫(VIP)中關于氨甲環痠對全髖關節置換術失血量影響的隨機對照研究，同時手檢納入文獻的參攷文獻，檢索時間截止到2013年9月。採用RevMan5.0軟件進行統計學分析，氨甲環痠組與安慰劑組總失血量和總輸血量採用加權均數差(WMD)評價，輸血率、深靜脈血栓髮生率採用相對危險度(RR)評價。
<br> 結果與結論：共納入前瞻性隨機對照研究16篇，樣本總量884例。Meta分析結果顯示，與安慰劑組相比，氨甲環痠能夠減少全髖關節置換患者平均總失血量261.42 mL (95%CI-334.25至-188.59，P<0.00001)、平均減少置換中失血量135.04 mL (95%CI-223.31至-46.77, P<0.01)、平均減少置換後失血量159.70 mL (95%CI -217.06至-102.34， P <0.00001),氨甲環痠同時可以顯著降低輸血率(RR 0.46,95%CI 0.36-0.59，P<0.00001)，而兩組間深靜脈血栓髮生率差異無顯著性意義。說明靜脈應用氨甲環痠能夠顯著減少全髖關節置換失血量，降低輸血率，但不增加關節置換後深靜脈血栓的髮生率。
배경：안갑배산시일충뢰안산합성연생물，타가이가역성적조단섬용매화섬용매원상뢰안산결합점종이발휘항섬유단백용해작용，목전이재심혈관외과치료중엄범사용병증실가이유효감소수술실혈량。
<br> 목적：통과Meta분석대안갑배산재감소전관관절치환실혈량적유효성화안전성진행평개。
<br> 방법：계산궤검색수거고MEDLINE、PubMed、EMBASE、Cochrane Library、중국기간전문수거고(CNKI)、유보중문과기기간수거고(VIP)중관우안갑배산대전관관절치환술실혈량영향적수궤대조연구，동시수검납입문헌적삼고문헌，검색시간절지도2013년9월。채용RevMan5.0연건진행통계학분석，안갑배산조여안위제조총실혈량화총수혈량채용가권균수차(WMD)평개，수혈솔、심정맥혈전발생솔채용상대위험도(RR)평개。
<br> 결과여결론：공납입전첨성수궤대조연구16편，양본총량884례。Meta분석결과현시，여안위제조상비，안갑배산능구감소전관관절치환환자평균총실혈량261.42 mL (95%CI-334.25지-188.59，P<0.00001)、평균감소치환중실혈량135.04 mL (95%CI-223.31지-46.77, P<0.01)、평균감소치환후실혈량159.70 mL (95%CI -217.06지-102.34， P <0.00001),안갑배산동시가이현저강저수혈솔(RR 0.46,95%CI 0.36-0.59，P<0.00001)，이량조간심정맥혈전발생솔차이무현저성의의。설명정맥응용안갑배산능구현저감소전관관절치환실혈량，강저수혈솔，단불증가관절치환후심정맥혈전적발생솔。
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.
<br> OBJECTIVE:To evaluate the effectiveness and safety of tranexamic acid treatment on reducing blood loss in total hip arthroplasty through a meta-analysis.
<br> METHODS:An online retrieval of Medline, PubMed, EMBASE, Cochrane Library, CNKI and VIP databases before September 2013 was performed for screening randomized control ed trials about the effect of tranexamic acid on blood loss in total hip arthroplasty. Meanwhile the references of the included literatures were manual y checked. Statistical analysis was performed using RevMan5.0 software. The blood loss volume and blood transfusion volume in tranexamic acid group and placebo group were evaluated using the weighted mean difference. The incidence of transfusion rate and deep vein thrombosis were calculated using risk ratio in two groups.
<br> RESULTS AND CONCLUSION:A total of 16 randomized control ed trials involving 884 patients were included. Meta-analysis results showed that, tranexamic acid reduced total blood loss of patients after total hip arthroplasty, by a mean of 261.42 mL (95%CI-334.25 to-188.59, P<0.000 01), intraoperative blood loss by a mean of 135.04 mL (95%CI-223.31 to-46.77, P<0.01) and postoperative blood loss by a mean of 159.70 mL (95%CI-217.06 to-102.34, P<0.000 01). Tranexamic acid also led to a significant reduction in transfusion requirements (RR 0.46, 95%CI 0.36 to 0.59, P<0.000 01). There was no significant difference in the risk of deep vein thrombosis between the two groups. Tranexamic acid significantly reduces blood loss and blood transfusion requirements in patients undergoing total hip arthroplasty, and cannot increase the risk of deep vein thrombosis.
