围手术期静脉应用抗纤维蛋白溶解药在脊柱手术中止血作用的Meta分析

Meta-analysis on antifibrinolytic agents for spinal surgery

中文关键词:  抗纤维蛋白溶解药  脊柱手术  止血  Meta分析

英文关键词:Antifibrinolytic agents  Spinal surgery  Hemostasis  Meta-analysis

中文摘要:

  【摘要】 目的：系统评价围手术期静脉应用抗纤维蛋白溶解药在脊柱手术中的止血作用。方法：计算机检索2016年6月1日以前PubMed、Embase、Medline、Cochrane Library关于脊柱手术中围手术期静脉应用抗纤维蛋白溶解药的随机对照试验（randomized controlIedtrials，RCT）文献，纳入文献的方法学质量采用改良Jadad量表评价。抗纤维蛋白溶解药（antifibrinolytic agents，AA）包括氨甲环酸（tranexamic acid，TXA）和氨基己酸（epsilon aminocaproic acid，EACA）；对照组（control group，CG）药物为Placebo。提取各研究中的总失血量、术中失血量、术后引流量、总输血量、术中输血事件、术后输血事件、手术时间与不良事件数据，并将这些研究的数据通过Review Manager 5.3软件进行Meta分析。结果：共纳入18篇文献、1571例患者。纳入文献的方法学质量由改良Jadad量表评价，9篇文献的研究质量评分为5分，6篇为4分，3篇为3分。纳入18篇研究均为RCT。Meta分析结果显示，共10项研究报道了围手术期总失血量情况：Placebo组高于TXA组[SMD=-0.95；95%CI：（-1.28，-0.62），P＜0.00001]；Placebo组高于EACA组[SMD=-0.91；95%CI：（-1.24，-0.58），P＜0.00001]；TXA与EACA组两组比较差异无统计学意义[SMD=0.13；95%CI:（-0.47，-0.73），P=0.67]。共13项研究报道了术中失血量情况：Placebo组高于TXA组[SMD=-0.47；95%CI：（-0.66，-0.29），P＜0.00001]；Placebo组高于EACA组[SMD=-1.01；95%CI：（-1.56，-0.47），P＜0.0003]；TXA组高于EACA组[SMD=0.47；95%CI:（0.13，0.81），P=0.007]。共8项研究报道了术后引流量情况：Placebo组高于TXA组[SMD=-0.74；95%CI:（-1.13，-0.34），P=0.0002]；Placebo组高于EACA组[SMD=-0.80；95%CI：（-1.44，-0.16），P=0.01]；TXA组与EACA组两组比较差异无统计学意义[SMD=0.06；95%CI：（-1.02，1.14），P=0.92]。共7项研究报道了总输血量情况：AA组少于CG组，两组比较差异具有统计学意义[SMD=-0.51；95%CI：（-0.67，-0.34），P＜0.00001]。共4项研究报道了术中输血事件，AA组与CG组两组比较差异无统计学意义[RR=0.91；95%CI：（0.68，1.21），P=0.52]。共6项研究报道了术后输血事件情况，AA组少于CG组，两组比较差异具有统计学意义[RR=0.44；95%CI：（0.31，0.62），P＜0.00001]。共8项研究报道了手术时间情况，AA组与CG组两组比较差异无统计学意义[SMD=-0.04；95%CI：（-0.21，0.14），P=0.69]。共3项研究报道了术后不良事件，AA组与CG组两组比较差异无统计学意义[RR=1.07；95%CI:（0.24，4.81），P=0.93]。结论：围手术期静脉应用抗纤维蛋白溶解药能够降低患者总失血量、术中失血量、术后引流量、总输血量及术后输血事件，但未能降低术中输血事件、手术时间及改善术后不良事件。

英文摘要:

  【Abstract】 Objectives: To systematically assess the antifibrinolytic agents for spinal surgery. Methods: According to the computer-based online search of PubMed, Embase, Medline, Cochrane Library, CBM, CNKI, Wanfang Database, VIP for articles published before June 1st, 2016 were searched for articles on antifibrinolytic agents(AA) for spinal surgery. Group AA included tranexamic acid(TXA) and epsilon aminocaproic acid(EACA); control group(CG) included placebo. 18 randomized controlled trials(RCTs) were included for the present study． Two authors independently assessed trial quality and extracted data． The data of total blood loss, intraoperative blood loss, postoperative blood loss, total blood transfusion, intraoperative transfusion, postoperative transfusion, operation time, adverse events were abstracted and synthesized by Review Manager 5.3 for Meta-analysis. Reasults: 18 studies were included with a total of 1571 patients. The methodological quality score of 9 RCT studies included in the Meta-analysis was 5, which of 6 studies was 4 and 3 studies was 3. Ten studies with total blood loss were reported: TXA VS. Placebo[SMD=-0.95; 95%CI:(-1.28, -0.62), P＜0.00001]; EACA VS. Placebo[SMD=-0.91; 95%CI:(-1.24, -0.58), P＜0.00001]; TXA VS. EACA[SMD=0.13; 95%CI:(-0.47, -0.73), P=0.67]. 13 studies with intraoperative blood loss were reported: TXA VS. Placebo[SMD=-0.47; 95%CI:(-0.66, -0.29), P＜0.00001]; EACA VS. Placebo[SMD=-1.01; 95%CI:(-1.56, -0.47), P＜0.0003]; TXA VS. EACA[SMD=0.47; 95%CI:(0.13, 0.81), P=0.007]. 8 studies with postoperative blood loss were reported: TXA VS. Placebo[SMD=-0.74; 95%CI:(-1.13, -0.34), P=0.0002]; EACA VS. Placebo Placebo[SMD=-0.80; 95%CI:(-1.44, -0.16), P=0.01]; TXA VS. EACA [SMD=0.06; 95%CI:(-1.02, 1.14), P=0.92]. 7 studies with total blood transfusion were reported [SMD=-0.51; 95%CI:(-0.67, -0.34), P＜0.00001]. 4 studies with intraoperative transfusion were reported [RR=0.91; 95%CI:(0.68, 1.21), P=0.52]. 6 studies with postoperative transfusion were reported[RR=0.44; 95%CI:(0.31, 0.62), P＜0.00001]. 8 studies with operation time were reported [SMD=-0.04; 95%CI:(-0.21, 0.14), P=0.69]. 3 studies with adverse events were reported [RR=1.07; 95%CI:(0.24, 4.81), P=0.93]. Conclusions: Administration of antifibrinolytic agents in perioperative period of spinal surgery may help not in reducing total blood loss, intraoperative blood loss, postoperative blood loss, total blood transfusion,postoperative transfusion, but in intraoperative transfusion, operation time, adverse events.