【摘要】：目的系統(tǒng)評價氨甲環(huán)酸在肝移植手術中血液保護方面的有效性和安全性。方法計算機檢索Cochrane圖書館、MEDLINE、CNKI、VIP、CBM(均從建庫至2017年5月),收集所有氨甲環(huán)酸用于肝移植手術的隨機對照試驗。使用Cochrane系統(tǒng)評價方法對納入研究進行質(zhì)量評價后,采用Rev Man 5.3軟件進行Meta分析。結果 1)4篇文獻比較了術后出血量,各研究間均存在統(tǒng)計學異質(zhì)性(I2=94%,P0.05),氨甲環(huán)酸與安慰劑相比,能減少術出血量[SMD=-1.95,95%CI(-3.21,-0.69)],P0.05]。2)4篇文獻報道了輸注紅細胞量,結果顯示氨甲環(huán)酸能減少術中輸注紅細胞的量[SMD=-0.43,95%CI(-0.74,-0.11)],P0.05];3篇文獻報道了比較了術中血漿輸注量,1篇文獻報道了安慰劑組比氨甲環(huán)酸組術中血小板輸注情況,結果表明氨甲環(huán)酸不能減少術中輸注血漿和血小板的量。氨甲環(huán)酸與安慰劑以及其他抗纖溶藥術后再次手術、術后出血、腎功能不全、血栓、感染、死亡其他不良事件發(fā)生率等不良事件發(fā)生率不增加。結論氨甲環(huán)酸可減少術中出血量及紅細胞輸入量,是1種安全有效的抗纖溶止血藥物,限于納入研究方法學質(zhì)量上的局限性,本系統(tǒng)評價結果尚需更多高質(zhì)量的隨機對照試驗進一步驗證。
[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.
【作者單位】： 復旦大學附屬中山醫(yī)院輸血科;復旦大學附屬中山醫(yī)院上海市器官移植重點實驗室;
【基金】：復旦大學附屬中山醫(yī)院青年基金(2017ZSQN43)
【分類號】：R657.3

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