氨甲环酸局部与静脉应用在初次单侧全髋关节置换围手术期安全性及有效性的Meta分析Topical versus intravenous application of tranexamic acid during primary unilateral total hip arthroplasty:a meta-analysis
徐闯;刘明廷;孟涛;石辉;王建明;李健;杜长岭;
摘要(Abstract):
[目的]用Meta分析的方法探讨局部与静脉应用氨甲环酸(tranexamic acid,TXA)对全髋关节置换术(total hip arthroplasty,THA)的安全性及有效性。[方法]计算机检索Pub Med、EBSCO、The Cochrane Library数据库、中国知网、万方数据库,检索内容为关于局部应用TXA减少THA出血量的临床随机对照试验(randomized controlled trial,RCT)和半随机对照试验(q RCT),检索时限为1999年1月~2016年6月。按纳入、排除标准进行文献筛选和质量评估,应用Rev Man 5.2软件进行Meta分析。[结果]纳入8篇文献,2 144例患者,局部应用氨甲环酸组789例,静脉组1 355例。Meta分析结果显示:(1)安全性:局部组与静脉组相比,术后深静脉血栓(DVT)发生率[RR=0.76,95%CI(0.22,2.59),P=0.66]、肺栓塞(PE)发生率[RR=0.73,95%CI(0.08,7.02),P=0.79]、切口感染率[RR=1.26,95%CI(0.54,2.93),P=0.59]差异均无统计学意义;(2)有效性:局部组与静脉组对比,术后总失血量[WMD=16.75,95%CI(-30.07,63.57),P=0.48]、血红蛋白下降值[WMD=0.30,95%CI(0.02,0.58),P=0.03]、输血率[RR=1.37,95%CI(0.97,1.93),P=0.07]差异均无统计学意义。[结论]初次单侧全髋关节置换术局部应用氨甲环酸与静脉应用相比具有相当的安全性和有效性。
关键词(KeyWords): 局部;关节腔;静脉;氨甲环酸;全髋关节置换术;Meta分析;安全性;有效性
基金项目(Foundation): 山东省自然科学基金(编号:ZR2015PH006)
作者(Author): 徐闯;刘明廷;孟涛;石辉;王建明;李健;杜长岭;
Email:
DOI:
参考文献(References):
- [1]Zhao J,Li J,Zheng W,et al.Low body mass index and blood loss in primary total hip arthroplasty:results from 236 consecutive ankylosing spondylitis patients.[J].Biomed Res Int,2014,2014(1):971-975.
- [2]Bruce W,Campbell D,Daly D,et al.Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery[J].Anz J Surg,2013,83(4):222-229.
- [3]Madjdpour C,Spahn DR.Allogeneic red blood cell transfusions:efficacy,risks,alternatives and indications[J].BJA,2005,95(95):33-42.
- [4]Wang W,Liao Q,Wu X,et al.Potential risk of blood transfusiontransmitted brucellosis in an endemic area of China[J].Transfusion,2015,55(3):586-592.
- [5]Malhotra S,Dhawan HK,Jain A,et al.Acute hemolytic transfusion reaction in a patient with bombay phenotype:implications for ABOgrouping[J].Ind J Hematol Blood Trans,2014,30(1):108-110.
- [6]Liu X,Zhang X,Chen Y,et al.Hidden blood loss after total hip arthroplasty[J].J Arthroplasty,2011,26(7):1100-1105.
- [7]Alshryda S,Mason J,Sarda P,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total hip replacement[J].J Bone Joint Surg Am,2013,95(21):1969-1974.
- [8]Moskal JT,Capps SG.Meta-analysis of intravenous tranexamic acid in primary total hip arthroplasty[J].Orthopedics,2016,39(15):883-892.
- [9]Zhou X,Tao L,Li J,et al.Do we really need tranexamic acid in total hip arthroplasty?A meta-analysis of nineteen randomized controlled trials[J].Arch Orthop Trauma Surg,2013,133(7):1017-1027.
- [10]Sukeik M,Alshryda S,Haddad FS,et al.Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement[J].Bone Joint J,2011,93(1):39-46.
- [11]Konig G,Hamlin BR,Waters JH.Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty[J].J Arthroplasty,2013,28(9):1473-1476.
- [12]Fan FC,Gui BJ.Tranexamic acid injection through articular cavity and discontinuous clip pipe after total hip arthroplasty:changes in bleeding amount[J].Chin J Tissue Eng Res,2014,18(40):6397-6402.
- [13]ClavéA,Fazilleau F,Dumser D,et al.Efficacy of tranexamic acid on blood loss after primary cementless total hip replacement with rivaroxaban thromboprophylaxis:a case-control study in 70 patients[J].Orthop Traumatol Surg Res,2012,98(5):484-490.
- [14]Wind TC,Barfield WR,Moskal JT.The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty[J].J Arthroplasty,2014,29(2):387-389.
- [15]Wei W,Wei B.Comparison of topical and intravenous tranexamic acid on blood loss and transfusion rates in total hip arthroplasty[J].J Arthroplasty,2014,29(11):2113-2116.
- [16]North WT,Mehran N,Davis JJ,et al.Topical vs intravenous tranexamic acid in primary total hip arthroplasty:a double-blind,randomized controlled trial[J].J Arthroplasty,2016,31(5):1022-1026.
- [17]Xie J,Ma J,Yue C,et al.Combined use of intravenous and topical tranexamic acid following cementless total hip arthroplasty:a randomised clinical trial[J].Hip Int,2016,26(1):36-42.
- [18]Ueno M,Sonohata M,Fukumori N,et al.Comparison between topical and intravenous administration of tranexamic acid in primary total hip arthroplasty[J].J Orthop Sci,2016,21(1):44-47.
- [19]岳辰,谢锦伟,蔡东峰,等.静脉联合局部应用氨甲环酸减少初次全髋关节置换术围手术期失血的有效性及安全性研究[J].中国骨与关节外科,2015(1):44-48.
- [20]张立,王代荣,赵国平,等.氨甲环酸静脉联合局部应用在全髋关节置换术中的疗效评价[J].实用医学杂志,2015,31(20):3358-3360.
- [21]赵清斌,任姜栋,张晓岗,等.氨甲环酸静脉或局部及联合应用初次单侧全髋关节置换:围置换期出血及输血率的比较[J].中国组织工程研究,2016,20(4):459-464.
- [22]Gill JB,Rosenstein A.The use of antifibrinolytic agents in total hip arthroplasty:a meta-analysis[J].J Arthroplasty,2006,21(6):869-873.
- [23]Lemaire R.Strategies for blood management in orthopaedic and trauma surgery[J].J Bone Joint Surg Am,2008,90(9):1128-1136.
- [24]Alshryda S,Mason J,Vaghela M,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total knee replacement[J].J Bone Joint Surg Am,2013,95(21):1961-1968.
- [25]Van Elst CE,Vanbiervliet J,Simon JP,et al.The Effect of topical application of tranexamic acid in total hip arthroplasty through the direct anterior approach[R].American Academy of Orthopaedic Surgeons Annual Meeting March,2013.
- [26]谢锦伟,岳辰,裴福兴.氨甲环酸在全髋关节置换术中的有效性与安全性研究进展[J].中国矫形外科杂志,2014,22(20):1856-1860.
- [27]孙程,陆海明,吕杰,等.氨甲环酸在初次全髋关节置换术中的应用[J].中国矫形外科杂志,2015,23(2):139-143.
- [28]Ralley FE,Berta D,Binns V,et al.One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty[J].Clin Orthop,2010,468(7):1905-1911.
- [29]Gillette BP,De Simone LJ,Trousdale RT,et al.Low risk of thromboembolic complications with tranexamic acid after primary total hip and knee arthroplasty[J].Clin Orthop,2013,471(1):150-154.
- [30]Gandhi R,Evans HMK,Mahomed SR,et al.Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty:a meta-analysis[J].BMC,2013,6(1):1.
- [31]Oremus K,Sostaric S,Trkulja V,et al.Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty:a randomized controlled trial[J].Transfusion,2014,54(1):31-41.
- [32]岳辰,康鹏德,沈彬,等.氨甲环酸用于首次髋关节置换术的系统评价和Meta分析[J].中国矫形外科杂志,2013,21(12):1167-1172.