局部应用和静脉注射氨甲环酸对全膝关节置换术术后出血影响的Meta分析Influence of topical versus intravenous tranexamic acid injection on blood loss after primary total knee arthroplasty: a meta- analysis
董翠翠;贺付成;
摘要(Abstract):
[目的]采用系统评价及Meta分析的方法对局部应用和静脉注射氨甲环酸两种方式减少全膝关节置换术术后出血的临床效果进行评价。[方法]检索Cochrane Library、Medline、Embase、Pubmed英文数据库以及CBM、VIP、万方数据库、CNKI,检索内容为局部应用和静脉注射氨甲环酸的临床对照试验,使用Revman 5.30进行Meta分析。[结果]共纳入11篇文献,纳入患者1 948例,其中局部应用氨甲环酸754例,静脉注射氨甲环酸1 194例。局部应用与静脉注射氨甲环酸在术后失血量、术后输血率及血栓事件的发生方面差异均无统计学意义(P>0.05)。[结论]局部应用与静脉注射氨甲环酸在减少TKA术后出血的有效性和安全性并无差异,两种用药方式均可以减少TKA术后出血而不增加其血栓形成的风险。
关键词(KeyWords): 氨甲环酸;静脉注射;局部应用;全膝关节置换术;荟萃分析
基金项目(Foundation):
作者(Author): 董翠翠;贺付成;
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参考文献(References):
- [1]Bong MR,Patel V,Chang E,et al.Risks associated with blood transfusion after total knee arthroplasty[J].J Arthroplasty,2004,19(3):281-287.
- [2]Freedman J,Luke K,Monga N,et al.A provincial program of blood conservation:The Ontario Transfusion Coordinators(ONTra C)[J].Transfus Apher Sci,2005,33(3):343-349.
- [3]Shander A,Hofmann A,Ozawa S,et al.Activity-based costs of blood transfusions in surgical patients at four hospitals[J].Transfusion,2010,50(4):753-765.
- [4]唐炼.氨甲环酸对膝关节置换术患者静脉与关节内失血的影响研究[J].中国生化药物杂志,2014,34(7):105-107.
- [5]韩文锋,张珑,张攀,等.局部和静脉应用氨甲环酸减少初次全膝关节置换术后失血量对比研究[J].国际骨科学杂志,2014,35(4):269-271.
- [6]Sarzaeem MM,Razi M,Kazemian G,et al.Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty[J].J Arthroplasty,2014,29(8):1521-1524.
- [7]Soni A,Saini R,Gulati A,et al.Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty[J].J Arthroplasty,2014,29(8):1525-1527.
- [8]Patel JN,Spanyer JM,Smith LS,et al.Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty:a prospective randomized study[J].J Arthroplasty,2014,29(8):1528-1531.
- [9]Maniar RN,Kumar G,Singhi T,et al.Most effective regimen of tranexamic acid in knee arthroplasty:a prospective randomized controlled study in 240 patients[J].Clin Orthop,2012,470(9):2605-2612.
- [10]Seo JG,Moon YW,Park SH,et al.The comparative efficacies of intra-articular and IV tranexamic acid for reducing blood loss during total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2013,21(8):1869-1874.
- [11]Gomez-Barrena E,Ortega-Andreu M,Padilla-Eguiluz NG,et al.Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement:a doubleblind,randomized,controlled,noninferiority clinical trial[J].J Bone Joint Surg Am,2014,96(23):1937-1944.
- [12]Wind TC,Barfield WR,Moskal JT.The effect of tranexamic acid on blood loss and transfusion rate in primary total knee arthroplasty[J].J Arthroplasty,2013,28:1080-1083.
- [13]Hegde C,Wasnik S,Kulkarni S,et al.Simultaneous bilateral computer assisted total knee arthroplasty:the effect of intravenous or intraarticular tranexamic acid[J].J Arthroplasty,2013,28(7):1888-1891.
- [14]Hamlin BR,Di Gioia AM,Plakseychuk AY,et al.Topical versus intravenous tranexamic acid in total knee arthroplasty[J].J Arthroplasty,2013,28(10):1888-1891.
- [15]Benoni G,Fredin H.Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty:a prospective,randomised,double-blind study of 86 patients[J].J Bone Joint Surg Br,1996,78(3):434-440.
- [16]Alshryda S,Sukeik M,Sarda P,et al.A systematic review and metaanalysis of the topical administration of tranexamic acid in total hip and knee replacement[J].Bone Joint J,2014,96-B(8):1005-1015.
- [17]张瑜哲,金毅,苏礼,等.氨甲环酸减少初次单侧全膝关节置换术后失血量的临床研究[J].中国矫形外科杂志,2013,21(8):762-765.
- [18]Wang H,Shen B,Zeng Y.Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty:a meta-analysis of randomized controlled and prospective cohort trials[J].Knee,2014,21(6):987-993.
- [19]Alshryda S,Mason J,Vaghela M,et al.Topical(intra-articular)tranexamic acid reduces blood loss and transfusion rates following total knee replacement:a randomized controlled trial(TRANX-K)[J].J Bone Joint Surg Am,2013,95(21):1961-1968.
- [20]Yang ZG,Chen WP,Wu LD.Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty:a meta-analysis[J].J Bone Joint Surg Am,2012,94:1153-1159.
- [21]Astedt B,Liedholm P,Wingerup L.The effect of tranexamic acid on the fibrinolytic activity of vein walls[J].Ann Chir Gynaecol,1978,67(6):203-205.