岳辰;康鹏德;沈彬;杨静;周宗科;谢小伟;裴福兴;

• 1:四川大学华西医院骨科

摘要(Abstract)：

[目的]评价氨甲环酸对首次全髋关节置换术中及术后失血量等指标的影响及其安全性。[方法]利用互联网全面检索数据库Ovid(1966～2012年11月)、PubMed(1966～2012年11月)、sciencedirect(1980～2012年11月),根据纳入排除标准,最后检索出氨甲环酸在首次全髋关节置换术中应用的高质量前瞻性随机对照研究,提取数据,采用RevMan 5.0软件进行Meta分析,根据分析结果得出结论。[结果]经过全面严格筛选,共纳入高质量(Jadad评分不少于3分)前瞻性随机对照研究13篇。Meta分析结果显示,使用氨甲环酸可以减少病人平均总失血量294.2 ml(95%CI-385.28～-203.04,P<0.000 01)、平均减少术中出血88.87 ml(95%CI-140.59～-37.16,P=0.000 8)、平均减少术后出血155.43 ml(95%CI-254.27～-56.60,P=0.002);氨甲环酸可以显著降低输血率19%(95%CI-0.31～-0.36);两组间深静脉血栓、肺栓塞发生率差异无统计学意义(P>0.1)。[结论]氨甲环酸能有效减少首次全髋关节置换术的失血量、降低输血率,且并未增加术后DVT及PE的发生率。

关键词(KeyWords)： 氨甲环酸;全髋关节置换术;失血;输血;Meta分析

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目资助(编号:81271976/H0605、81171763和30772202/C1607)

作者(Author): 岳辰;康鹏德;沈彬;杨静;周宗科;谢小伟;裴福兴;

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参考文献(References)：

• [1]Lemaire R.Strategies for blood management in orthopaedic and trau-ma surgery[J].J Bone Joint Surg Br,2008,90:1128-1136.
• [2]傅德杰,陈凯宁,杨柳.氨甲环酸对全膝关节置换术失血量影响的系统评价[J].中国矫形外科杂志,2012,13:1172-1177.
• [3]Claeys MA,Vermeersch N,Haentjens P.Reduction of blood loss withtranexamic acids in primary total hip replacement surgery[J].ActaChir Belg,2007,107:397-401.
• [4]Niskanen RO,Korkala OL.Tranexamic acid reduces blood loss in ce-mented hip arthroplasty:a randomized,double-blind study of 39 pa-tients with osteoarthritis[J].Acta Orthop,2005,76:829-832.
• [5]Garneti N,Field J.Bone bleeding during total hip arthroplasty afteradministration of tranexamic acid[J].J Arthroplasty,2004,19:488-492.
• [6]Benoni G,Lethagen S,Nilsson P,et al.Tranexamic acid,given at theend of the operation,does not reduce postoperative blood loss in hiparthroplasty[J].Acta Orthop Scand,2000,71:250-254.
• [7]Benoni G,Fredin H,Knebel R,et al.Blood conservation with tranex-amic acid in total hip arthroplasty:a randomized,double-blind studyin 40 primary operations[J].Acta Orthop Scand,2001,72:442-448.
• [8]Ekback G,Axelsson K,Ryttberg L,et al.Tranexamic acid reducesblood loss in total hip replacement surgery[J].Anesth Analg,2000,91:1124-1130.
• [9]Husted H,Blond L,Sonne-Holm S,et al.Tranexamic acid reducesblood loss and blood transfusions in primary total hip arthroplasty:aprospective randomized double blind study in 40 patients[J].ActaOrthop Scand,2003,74:665-669.
• [10]Johnasson T,Pettersson LG,Lisander B.Tranexamic acid in total hiparthroplasty saves blood and money:a randomized,double-blindstudy in 100 patients[J].Acta Orthop,2005,76:314-319.
• [11]Lemay E,Guay J,CtéC,et al.Tranexamic acid reduces the need forallogenic red blood cell transfusions in patients undergoing total hipreplacement[J].Can J Anaesth,2004,51:31-37.
• [12]Yamasaki S,Masuhara K,Fuji T.Tranexamic acid reduces blood lossafter cementless total hip arthroplasty-prospective randomized studyin 40 cases[J].Int Orthop,2004,28:69-73.
• [13]McConnell JS,Shewale S,Munro NA,et al.Reduction of blood loss inprimary hip arthroplasty with tranexamic acid or fibrin spray.A ran-domized controlled trial[J].Acta Orthop,2011,6:660-663.
• [14]Rajesparan K,Biant LC,Ahmad M,et al.The effect of an intravenousbolus of tranexamic acid on blood loss in total hip replacement[J].JBone Joint Surg Br,2009,91:776-783.
• [15]Kazemi SM,Mosaffa F,Eajazi A,et al.The effect of tranexamic acidon reducing blood loss in cementless total hip arthroplasty under epi-dural anesthesia[J].Orthopedics,2010,1:17.
• [16]Inga MA.Clinical pharmacology of aminocaproic and tranexamicacids[J].J Clin Pathol,33,14Suppl(Roy Coll Path):41-47.
• [17]Higgins JPT,Green S.Cochrane handbook for systematic reviews ofinterventions[J].Version,2005,2:5.