肝移植术中应用氨甲环酸对于术中出血的影响
发布时间：2019-01-16 02:56
【摘要】：目的系统评价氨甲环酸在肝移植手术中血液保护方面的有效性和安全性。方法计算机检索Cochrane图书馆、MEDLINE、CNKI、VIP、CBM(均从建库至2017年5月),收集所有氨甲环酸用于肝移植手术的随机对照试验。使用Cochrane系统评价方法对纳入研究进行质量评价后,采用Rev Man 5.3软件进行Meta分析。结果 1)4篇文献比较了术后出血量,各研究间均存在统计学异质性(I2=94%,P0.05),氨甲环酸与安慰剂相比,能减少术出血量[SMD=-1.95,95%CI(-3.21,-0.69)],P0.05]。2)4篇文献报道了输注红细胞量,结果显示氨甲环酸能减少术中输注红细胞的量[SMD=-0.43,95%CI(-0.74,-0.11)],P0.05];3篇文献报道了比较了术中血浆输注量,1篇文献报道了安慰剂组比氨甲环酸组术中血小板输注情况,结果表明氨甲环酸不能减少术中输注血浆和血小板的量。氨甲环酸与安慰剂以及其他抗纤溶药术后再次手术、术后出血、肾功能不全、血栓、感染、死亡其他不良事件发生率等不良事件发生率不增加。结论氨甲环酸可减少术中出血量及红细胞输入量,是1种安全有效的抗纤溶止血药物,限于纳入研究方法学质量上的局限性,本系统评价结果尚需更多高质量的随机对照试验进一步验证。
[Abstract]:Objective to evaluate the efficacy and safety of tranexamic acid in blood protection during liver transplantation. Methods A computerized search of Cochrane library, MEDLINE,CNKI,VIP,CBM (from the establishment of the library to May 2017), was conducted to collect all the randomized controlled trials of tranexamic acid for liver transplantation. Cochrane system evaluation method was used to evaluate the quality of the inclusion study, and Rev Man 5.3 software was used for Meta analysis. Results 1) the blood loss after operation was compared in four articles. There was statistical heterogeneity among all the studies (P 0.05). Compared with placebo, the amount of blood loss was decreased by methacylic acid [SMD=-1.95,95%CI (-3.21), but no significant difference was found between the two groups (P < 0.05). The quantity of red blood cell was reported in 4 papers. The results showed that the amount of erythrocyte was decreased by methachloric acid [SMD=-0.43,95%CI (-0.74 ~ -0.11)], P0.05]. The intraoperative plasma infusion volume was compared in 3 papers and the platelet transfusion in placebo group was reported. The results showed that the intraoperative infusion of plasma and platelet could not be reduced. There was no increase in the incidence of adverse events such as postoperative bleeding renal insufficiency thrombus infection death and other adverse events after reoperation of carbamicycline placebo and other antifibrinolytic drugs. Conclusion it is a safe and effective antifibrinolytic hemostatic drug, which can reduce the amount of blood loss and red blood cell input during operation, and is limited to the limitation of the quality of the methodology involved in the study. The results of this system need more high-quality randomized controlled trials to be further verified.
【作者单位】： 复旦大学附属中山医院输血科;复旦大学附属中山医院上海市器官移植重点实验室;
【基金】：复旦大学附属中山医院青年基金(2017ZSQN43)
【分类号】：R657.3
[Abstract]:Objective to evaluate the efficacy and safety of tranexamic acid in blood protection during liver transplantation. Methods A computerized search of Cochrane library, MEDLINE,CNKI,VIP,CBM (from the establishment of the library to May 2017), was conducted to collect all the randomized controlled trials of tranexamic acid for liver transplantation. Cochrane system evaluation method was used to evaluate the quality of the inclusion study, and Rev Man 5.3 software was used for Meta analysis. Results 1) the blood loss after operation was compared in four articles. There was statistical heterogeneity among all the studies (P 0.05). Compared with placebo, the amount of blood loss was decreased by methacylic acid [SMD=-1.95,95%CI (-3.21), but no significant difference was found between the two groups (P < 0.05). The quantity of red blood cell was reported in 4 papers. The results showed that the amount of erythrocyte was decreased by methachloric acid [SMD=-0.43,95%CI (-0.74 ~ -0.11)], P0.05]. The intraoperative plasma infusion volume was compared in 3 papers and the platelet transfusion in placebo group was reported. The results showed that the intraoperative infusion of plasma and platelet could not be reduced. There was no increase in the incidence of adverse events such as postoperative bleeding renal insufficiency thrombus infection death and other adverse events after reoperation of carbamicycline placebo and other antifibrinolytic drugs. Conclusion it is a safe and effective antifibrinolytic hemostatic drug, which can reduce the amount of blood loss and red blood cell input during operation, and is limited to the limitation of the quality of the methodology involved in the study. The results of this system need more high-quality randomized controlled trials to be further verified.
【作者单位】： 复旦大学附属中山医院输血科;复旦大学附属中山医院上海市器官移植重点实验室;
【基金】：复旦大学附属中山医院青年基金(2017ZSQN43)
【分类号】：R657.3
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