氨甲环酸在青少年特发性脊柱侧凸矫形术中应用安全性及有效性的Meta分析

Meta-analysis of safety and effectiveness of tranexamic acid in orthopedic surgery for patients with adolescent idiopathic scoliosis

中文关键词:  氨甲环酸  特发性脊柱侧凸  失血量  脊柱手术  Meta分析

英文关键词:Tranexamic Acid  Idiopathic Scoliosis  Blood Loss  Spinal Surgery  Meta Analysis

中文摘要:

  【摘要】 目的：系统分析氨甲环酸（tranexamic acid，TXA）在青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者矫形术中应用的有效性和安全性。方法：在Cochrane library、Web of Science、Embase、PubMed、中国期刊全文数据库（CNKI）和万方数据知识服务平台检索关于TXA在AIS患者矫形术中应用的随机对照研究（randomized controlled trial，RCT）和回顾性对照研究（retrospective cohort studies，RCS）文献，检索时间范围从建库至2023年12月，语种不限。由研究者对所纳入的文献进行质量评估，RCT文献使用Cochrane评价表进行评估，RCS文献使用纽卡斯尔-渥太华量表（the Newcastle-Ottawa Scale，NOS）进行评估，然后提取各研究中的结局指标，包括总失血量、术中失血量、术后引流量、输血率、术后血红蛋白（hemoglobin，Hb）值、手术时间、深静脉血栓及相关并发症，将所提取的数据使用RevMan 5.4软件进行统计学分析与评价，评估TXA在AIS患者矫形术中应用的效果。结果：共纳入8篇RCT文献和5篇RCS文献，均为高质量文献，共计855例患者，其中TXA组439例，对照组416例。Meta分析结果显示，TXA组术中失血量低于对照组[均数差（mean difference，MD）＝-310.81，95%置信区间（confidence interval，CI）为（-331.91，-289.72），P＜0.01]；总失血量低于对照组[MD＝-431.92，95%CI为（-568.72，-295.13），P＜0.01]；术后引流量低于对照组[MD＝-59.87，95%CI为（-63.98， -55.75），P＜0.01]；输血率低于对照组[比值比（odds ratio，OR）＝0.17，95%CI为（0.05，0.53），P＝0.003]；手术时间低于对照组[MD＝-5.94，95%CI为（-10.73，-1.14），P＝0.02]；术后Hb值高于对照组[MD＝-0.40，95%CI为（-0.26，0.54），P＜0.01]；均无深静脉血栓及相关并发症发生。结论：TXA可有效减少AIS患者矫形术中失血量、总失血量、术后引流量、输血率、手术时间，维持术后Hb水平，且不会增加血栓及相关并发症发生的风险。

英文摘要:

  【Abstract】 Objectives: To systematically analyze the effectiveness and safety of tranexamic acid(TXA) in orthopedic surgery for patients with adolescent idiopathic scoliosis(AIS). Methods: Literature concerning the use of TXA in the orthopedic surgery of AIS patients of randomized controlled trial(RCT) and retrospective cohort studies(RCSs) were searched in the Cochrane library, Web of Science, Embase, PubMed, China National Knowledge Infrastructure(CNKI), and Wanfang Data Knowledge Service Platform, from the inception of the databases to December 2023. The quality of the included literature was evaluated by researchers according to Cochrane evaluation scale for RCT studies and Newcastle-Ottawa Scale(NOS) for RCS studies. The outcome indicators were extracted, including total blood loss, intraoperative blood loss, postoperative drainage, blood transfusion rate, postoperative hemoglobin(Hb) value, operation time, incidence of deep venous thrombosis and related complications. RevMan 5.4 software was used to analyze statistically the extracted data to evaluate the effect of TXA in orthopedic surgery for AIS patients. Results: A total of 8 RCT and 5 RCS studies were included, and all of which were of high-quality, covering 855 patients, with 439 cases in the TXA group and 416 cases in the control group. Meta-analysis results showed that comparing with the control group, the TXA group was lower in intraoperative blood loss[mean difference(MD)=-310.81, 95% confidence interval(CI) (-331.91, -289.72), P<0.01], total blood loss[MD=-431.92, 95%CI(-568.72, -295.13), P<0.01], postoperative drainage[MD=-59.87, 95%CI(-63.98, -55.75), P<0.01], and the blood transfusion rate[odds ratio(OR)=0.17, 95%CI(0.05, 0.53), P=0.003]; shorter in the operation time [MD=-5.94, 95%CI(-10.73, -1.14), P=0.02] and higher in the Hb value after operation[MD=-0.40, 95%CI(-0.26, 0.54), P＜0.01]. No deep venous thrombosis or related complications occurred in both groups. Conclusions: TXA can effectively reduce the intraoperative blood loss, total blood loss, postoperative drainage, blood transfusion rate and operation time in the orthopedic surgery of AIS patients, and maintain the postoperative Hb level without raising the likelihood of thrombosis and related complications.