氨甲环酸在腰椎后路椎间融合术患者中应用的安全性及有效性Meta分析

Meta-analysis of the safety and effectiveness of tranexamic acid in the posterior lumbar interbody fusion technique

中文关键词:  腰椎后路椎间融合术  氨甲环酸  失血量  血栓  Meta分析

英文关键词:Posterior lumbar interbody fusion  Tranexamic acid  Blood loss  Thrombosis  Meta analysis

中文摘要:

  【摘要】 目的：系统性分析腰椎后路椎间融合术（posterior lumbar interbody fusion，PLIF）患者应用氨甲环酸（tranexamic acid，TXA）止血的效果和安全性。方法：分别对数据库Pub Med、Cochrane Library、Web of Science、Embase、万方数据中关于PLIF患者术中使用TXA的随机对照研究（randomized controlled trial，RCT）论文进行检索，检索时间从建库到2019年11月，语种不限。对纳入的文献进行质量评估，记录各研究的作者、样本量、研究设计类型、TXA剂量等，提取各研究中的术中出血量、输血例数、总失血量、引流量、手术时间及深静脉血栓发生率等指标，应用Revman 5.3软件进行Meta分析。结果：共有11篇RCT纳入本研究，共计1105例患者，其中TXA组562例，对照组543例。TXA组术中出血量低于对照组[mean difference（MD）=-53.90，95%可信区间（confidence interval，CI）为（-76.29，-31.51），P＜0.05]，输血率低于对照组[OR=0.43，95%CI为（0.31，0.61）]；总失血量少于对照组[MD=-224.67，95%CI为（-313.60，-135.74），P＜0.05]；术后引流量小于对照组 [MD=-117.25， 95%CI为（-126.21，-108.29），P＜0.05]； 手术时间略短于对照组 [MD=-4.54，95%CI为（-7.69， -1.38），P＜0.005]；深静脉血栓形成发生率与对照组无显著性差异[OR=0.28，95%CI为（0.09，0.80），P＞0.05]。结论：PLIF时应用TXA可以减少患者术中出血量、总失血量、引流量、输血事件发生率及手术时间，且不会增加深静脉血栓形成的风险。

英文摘要:

  【Abstract】 Objectives: To systematically analyze the efficacy and safety of tranexamic acid(TXA) hemostasis in patients undergoing posterior lumbar interbody fusion(PLIF) surgery. Methods: Researchers searched the databases of PubMed, Cochrane library, Web of Science, Embase, and Wanfang for randomized controlled trials (RCT) on the use of TXA in PLIF surgery. The retrieval time was from the establishment of the database to November 2019, and the language was not limited. The researchers assessed the quality of the included studies, and extracted the outcome indicators of each study(intraoperative blood loss, number of blood transfusions, total blood loss, drainage volume, operation time, and incidence of deep vein thrombosis) into an electronic baseline table. The data of these studies were analyzed and evaluated by Revma 5.3 software. Results: 11 RCTs were finally included in the study, with a total of 1,105 patients including 562 in the TXA group and 543 in the control group. The outcome indicators were compared: intraoperative blood loss: TXA group[MD=-53.9, 95%CI(-76.29, -31.51)] was lower than in the control group(P<0.05); The number of blood transfusion: The incidence of TXA group[OR=0.43, 95%CI(0.31, 0.61)] was lower than the latter(P<0.05); Total blood loss: TXA group[MD=-224.67, 95%CI(-313.60, -135.74)] lower than the latter(P<0.05); Drainage volume: TXA group[MD=-117.25, 95%CI(-126.21, -108.29)] lower than the latter(P<0.05); Operation time: TXA group[MD=-4.54, 95%CI (-7.69, -1.38)] slightly lower than the latter(P<0.005); Deep vein thrombosis: TXA group[OR=0.28, 95%CI (0.09, 0.80)] not significantly different from the latter(P>0.05). Conclusions: TXA in patients with degenerative lumbar disc herniation, stenosis or instability undergoing PLIF operation can reduce intraoperative blood loss, total blood loss, drainage, blood transfusion incidence rate and operation time, and will not increase thrombosis during PLIF operation the risk of forming an event.