氨甲环酸在腰椎后路融合术围手术期的有效性与安全性meta分析

艾克拜尔江·艾赛提; 阿卜杜吾普尔·海比尔; 谷雯竹; 库提鲁克·守克尔; 沙拉依丁·艾尔西丁; 阿力木江·阿不都肉苏力; 罗雪峰

doi:10.16766/j.cnki.issn.1674-4152.004144

氨甲环酸在腰椎后路融合术围手术期的有效性与安全性meta分析

doi: 10.16766/j.cnki.issn.1674-4152.004144

1.
新疆医科大学第六附属医院骨科，新疆乌鲁木齐 830002
2.
新疆医科大学第六附属医院检验科
3.
新疆医科大学第一附属医院骨科，新疆乌鲁木齐 830011

基金项目:

国家自然科学基金项目 82260252

国家自然科学基金项目 8237152292

新疆维吾尔自治区自然科学基金资助项目面上项目 2022D01C221

新疆维吾尔自治区卫生健康委员会2022年度“青年科研启航”专项基金 2022YFY-QKQN-21

新疆维吾尔自治区自然科学基金科技援疆项目 2022E02128

详细信息

通讯作者:
罗雪峰，E-mail：345900233@qq.com

中图分类号: R687.3
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- 被引次数: 0
出版历程
- 收稿日期: 2024-08-15
- 网络出版日期: 2025-10-31

Meta-analysis of the efficacy and safety of tranexamic acid in the perioperative period of posterior lumbar fusion

1.
Department of Orthopedics, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830002, China

摘要

摘要: 目的采用meta分析对氨甲环酸(TXA)在腰椎后路椎间融合术(PLIF)围手术期中的有效性和安全性进行评估，研究其在减少手术出血并促进患者恢复方面的作用。方法检索PubMed、Cochrane Library、EMbase、中国知网、万方和维普数据库，纳入氨甲环酸用于PLIF围手术期的随机对照试验，筛选出22项研究(共2 577例患者，其中氨甲环酸组1 300例，对照组1 277例)。采用Endnote X9整理文献，Revman 5.3软件分析数据，观察指标包括术中失血量、总失血量等。结果 TXA应用于PLIF能显著降低术中失血量、总失血量与术后引流量，缩短手术时间，降低输血率，还能减少术后血红蛋白丢失量、红细胞压积下降幅度，缩短住院时间，且未增加术后并发症的发生风险。结论 TXA在PLIF围手术期中应用能减少相关失血量、输血率，缩短手术时间，改善指标变化，且未增加术后并发症的发生风险，可以在临床推广。
- 氨甲环酸 /
- 后路腰椎椎间融合术 /
- 失血量 /
- 随机对照试验 /
- Meta分析
Abstract: Objective To conduct a meta-analysis assessing the effectiveness and safety of tranexamic acid (TXA) during the perioperative period of posterior lumbar interbody fusion (PLIF), investigating its role in reducing surgical bleeding and promoting patient recovery. Methods PubMed, Cochrane Library, EMbase, CNKI, Wanfang, and VIP databases were searched for randomized controlled trials of tranexamic acid in the perioperative period of PLIF, and 22 studies (2 577 patients, 1 300 tranexamic acid group and 1 277 control group) were selected. Endnote X9 was used to organize the literature, Revman 5.3 software was used to analyze the data, and the detection indicators covered intraoperative blood loss, total blood loss, etc. Results The application of TXA to PLIF significantly reduced intraoperative and total blood loss and postoperative drainage, shortened the operation time, reduced the blood transfusion rate compared to the control group, and also reduced the postoperative hemoglobin loss and hematocrit, shortened the hospital stay, and did not increase the risk of postoperative complications. Conclusion The application of TXA in the perioperative period of PLIF can reduce the related blood loss and blood transfusion rate, shorten the operation time, improve the change of indicators, and does not increase the risk of postoperative complications, which supports clinical promotion.
- Tranexamic acid /
- Posterior lumbar interbody fusion /
- Blood loss /
- Randomized controlled trials /
- Meta-analysis

HTML全文

图 1 纳入文献的质量评估总图

注：“+”(绿色)为低风险，“?”(黄色)为风险未知，“-”(红色)为高风险。

Figure 1. The general quality assessment map of the included literature

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图 2 文献质量评估各项条目的百分比统计图

注：Low risk of bias(绿色)为低偏倚风险，Unclear risk of bias(黄色)为风险未知，High risk of bias(红色)为高偏倚风险。

Figure 2. Percentage statistics chart of each item in the literature quality assessment

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图 3 氨甲环酸组和对照组输血率比较

Figure 3. Comparison of blood transfusion rates between the tranexamic acid group and the control group

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图 4 氨甲环酸组和对照组术后并发症发生率比较

Figure 4. Comparison of the incidence of postoperative complications between the tranexamic acid group and the control group

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表 1 22篇研究的基本特征

Table 1. Basic characteristics of the 22 studies

纳入研究	发表国家	研究类型	样本量(男性/女性, 例)		年龄		干预方式		BMI		结局指标
纳入研究	发表国家	研究类型	TXA	对照组	TXA	对照组	TXA	对照组	TXA	对照组	结局指标
HE B, 2020^[8]	中国	RCT	8/12	11/9	57.95±12.44	57.90±11.76	A+B 10 mg/kg+6~ 8 mg/(kg·h)	0.9%生理盐水	25.02±5.19	24.75±4.42	①③④⑤⑩
KIM T K, 2014^[9]	韩国	RCT	12/12	15/9	61.0±9.0	65.2±7.0	A+B 10 mg/kg+ 2 mg/(kg·h)	0.9%生理盐水	25.9±3.2	25.1±3.2	①②③④⑥⑩
LIANG J, 2016^[10]	中国	RCT	14/16	15/15	63.1±7.1	53.6±6.4	C 2 000 mg	0.9%生理盐水	25.3±5.2	26.2±4.1	①③④⑤⑦⑧⑨
MU X, 2019^[11]	中国	RCT	27/18	23/19	54.20±7.37	52.57±6.73	A 15 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	24.83±1.95	23.93±1.35	①②③⑤⑥⑦⑧⑨
NAGABHUSHAN J, 2018^[12]	印度	RCT	9/16	11/14	49.60±9.79	51.72±9.71	A+B 10 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	51.72±9.71(体重)	60.96±7.35(体重)	①③④⑦⑧
OU Y, 2018^[13]	中国	RCT	30/29	31/28	64.2±4.6	64.0±5.1	A+C 15 mg/kg+1.0 g	0.9%生理盐水	22.64±3.29	22.57±3.2	①②③④⑤⑦⑧⑨
SHI H, 2017^[14]	中国	RCT	25/25	22/24	53.76±12.06	55.87±13.14	A+B 30 mg/kg+ 2 mg/(kg·h)	0.9%生理盐水	62.13±9.98(体重)	63.10±10.82(体重)	①②③④⑤⑦⑧
WANG J, 2013^[15]	中国	RCT	14/16	12/18	63.1±4.0	62.0±4.6	A 15 mg/kg	0.9%生理盐水	21.7±1.9	22.2±1.9	①②④⑨
XU D, 2020^[16]	中国	RCT	19/21	13/27	53.1±12.0	57.4±10.7	C 1 g	0.9%生理盐水	25.6±2.8	24.9±3.9	①②③④⑤⑨
YAN L, 2021^[17]	中国	RCT	16/24	22/18	53±7	52±8	A+B 20 mg/kg+ 10 mg/(kg·h)	0.9%生理盐水	70±10(体重)	67±12(体重)	①②④⑤⑥⑦⑧
ZHANG L, 2020^[18]	中国	RCT	47/91	57/94	57.04±10.20	54.73±9.93	A+C 1 g+1 g	0.9%生理盐水	25.20±3.54	25.82±3.28	①②③④⑤⑥⑦⑧
ZHU X, 2020^[19]	中国	RCT	22/28	21/29	56.0±9.5	54.8±10.3	A 15 mg/kg	0.9%生理盐水	23.8±2.9	23.8±2.8	①②③④⑤
ROOPA K N, 2018^[20]	印度	RCT	25	25	51.72±9.71	49.60±9.79	A+B 10 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	58.84±3.31(体重)	60.96±7.35(体重)	①②③④⑥
WONG J, 2008^[21]	加拿大	RCT	21/52	26/48	56.8±16.2	50.0±16.2	A+B 10 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	72.9±17.2(体重)	73.9±16.1(体重)	③④⑤⑩
WANG Q, 2018^[22]	中国	RCT	25/18	18/19	41.2±10.3	42.5±9.5	A+B 10 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	63.2±18.3(体重)	64.3±19.1(体重)	③④⑥⑩
SUN H, 2019^[23]	中国	RCT	45/45	22/15	57.12±11.55	51.51±13.57	A 15 mg/kg	0.9%生理盐水	24.86±4.72	24.44±3.57	①②③④⑤⑥
LI X, 2023^[24]	中国	RCT	74/138	84/143	55.40±10.61	55.26±10.44	A+C 2 g+1 g	0.9%生理盐水	25.73±3.31	25.71±3.63	①②④⑤⑥
WEI Y, 2023^[25]	中国	RCT	24/35	26/37	58.66±6.87	60.51±9.30	A 1 g	0.9%生理盐水	24.36±2.89	24.90±3.26	④⑤⑩
ELWATIDY S, 2008^[26]	沙·阿	RCT	21/11	18/14	51.56±19.08	49.75±21.04	A+B 30 mg/kg+ 1 mg(kg·h)	0.9%生理盐水	72.48±13.81(体重)	69.63±17.29(体重)	①②③④⑤
FARROKHI M R, 2011^[27]	德国	RCT	11/27	7/31	45.5±11.6	51.4±11.6	A+B 10 mg/kg+ 1 mg/(kg·h)	0.9%生理盐水	66.6±9.9(体重)	66.9±9.4(体重)	①②④⑤
GOLOVINA V A, 2017^[28]	德国	RCT	15/29	15/38	59.2	50.8	A+B 10 mg/kg+ 2 mg/(kg·h)	0.9%生理盐水	72.0(体重)	67.7(体重)	④⑤⑥
BU G Y, 2014^[29]	中国	RCT	102/31	109/25	54.2±13.1	52.6±16.3	C 1 000 mg	0.9%生理盐水	23.84±4.40	23.71±4.80	①③⑤
注：干预方式，A为静脉使用；B为术中维持；C为局部使用。结局指标，①术中失血量；②总失血量；③术后引流量；④手术时间；⑤输血率；⑥深静脉血栓发生率；⑦术后血红蛋白；⑧术后红细胞压积；⑨住院时间；⑩术后并发症发生率。

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