| 氨甲环酸和ε-氨基己酸在髋膝关节置换术中止血疗效的Meta分析 |
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Received:December 14, 2020
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| 期刊信息：《中国骨伤》2022年35卷，第5期，第484-490页 |
| DOI：10.12200/j.issn.1003-0034.2022.05.015 |
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目的:系统评价氨甲环酸和ε-氨基己酸在全髋关节置换术 (total hip arthroplasty,THA) 及全膝关节置换术 (total knee arthroplasty,TKA) 中的止血疗效。
方法:计算机检索建库至2020年7月PubMed,Embase,Cochrane Library,中国知网(CNKI),万方,维普(VIP)数据库发表的比较氨甲环酸和ε-氨基己酸治疗THA或TKA的临床随机对照研究 (randomized controlled trial,RCT) 和回顾性病例对照研究。由2位研究者分别根据纳入与排除标准进行文献筛选、数据提取,通过Cochrane Handbook对纳入的RCT进行方法学质量评价,通过纽卡斯尔-渥太华量表(newcastle-ottawa scale,NOS)对纳入的回顾性病例对照研究进行方法学质量评价,采用Review Manager 5.3软件对失血量、血栓并发症发生率、人均输入血红蛋白量进行Meta分析。
结果:最终共纳入6篇文献,包括4篇RCT,2篇回顾性病例对照研究,共计3 174例患者,其中氨甲环酸组1 353例,ε-氨基己酸组1 821例。Meta分析结果显示:在THA中,氨甲环酸组和ε-氨基己酸组失血量[MD=-88.60,95%CI(-260.30,83.10),P=0.31],输血率[OR=1.48,95%CI(0.96,2.27),P=0.08],血栓并发症发生率[OR=0.80,95%CI(0.07,8.83),P=0.85],人均输入血红蛋白量[MD=0.04,95%CI(-0.02,0.10),P=0.18]比较差异无统计学意义;在TKA中,氨甲环酸组失血量少于ε-氨基己酸组[MD=-147.13,95%CI(-216.52,-77.74),P<0.000 1]。而两组输血率[OR=1.30,95%CI(0.74,2.28),P=0.37],血栓并发症发生率[OR=0.95,95%CI(0.38,2.36),P=0.92],人均输入血红蛋白量[MD=-0.00,95%CI(-0.05,0.06),P=0.48],止血带时间[MD=1.54,95%CI(-2.07,5.14),P=0.40]比较差异无统计学意义。
结论:在THA中,氨甲环酸和ε-氨基己酸止血疗效相似;而在TKA中,氨甲环酸能有效减少患者失血量,具有更佳的止血疗效。推荐氨甲环酸作为TKA首选止血药物之一。 |
| [关键词]:关节成形术,置换 髋关节 膝关节 止血药 止血,手术 氨甲环酸 Meta分析 |
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| Hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in hip and knee arthroplasty:a Meta-analysis |
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Abstract:
Objective: To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods: Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed,EMbase,Cochrane Library,China National Knowledge Infrastructure (CNKI),Wanfang,VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook,and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss,the incidence of thrombosis complications,per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software.
Results: A total of 6 articles were included,including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients,including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss[MD=-88.60,95%CI(-260.30,83.10),P=0.31],blood transfusion rate[OR=1.48,95%CI(0.96,2.27),P=0.08],thrombotic complications[OR=0.80,95%CI(0.07,8.83),P=0.85],per capita hemoglobin input[MD=0.04,95%CI(-0.02,0.10),P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA,the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group[MD=-147.13,95%CI(-216.52,-77.74),P<0.0001],the difference was statistically significant. The blood transfusion rate[OR=1.30,95%CI(0.74,2.28),P=0.37],thrombotic complications[OR=0.95,95%CI(0.38,2.36),P=0.92],per capita hemoglobin input[MD=-0.00,95%CI(-0.05,0.06),P=0.48],tourniquet time[MD=1.54,95%CI(-2.07,5.14),P=0.40] were similar between two groups,the difference was not statistically significant.
Conclusion: In THA,tranexamic acid and ε-aminocaproic acid have similar hemostatic effects,while in TKA,tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA. |
| KEYWORDS:Arthroplasty,replacement Hip joint Knee joint Hemostatics Hemostasis,surgical Tranexamic acid Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张晋,杨自权.氨甲环酸和ε-氨基己酸在髋膝关节置换术中止血疗效的Meta分析[J].中国骨伤,2022,35(5):484~490 |
| 英文格式: | ZHANG Jin,YANG Zi-quan.Hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in hip and knee arthroplasty:a Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(5):484~490 |
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