【摘要】 目的探讨关节腔注射氨甲环酸(tranexamic acid,TXA)在全膝关节置换术(TKA)中应用的安全性和有效性。方法通过计算机检索Pub Med、Cochrane Library、Embase、CNKI、CBM、万方数据库有关TKA术中应用TXA行关节腔注射的随机对照试验(RCT)和半随机对照试验(q RCT),同时手工检索图书馆馆藏期刊。依照纳入标准对文献进行筛选、提取资料后,使用Cochrane系统评价方法评价纳入文献的质量,采用Rev Man 5.2对资料进行Meta分析。结果共纳入9个RCT和1个q RCT,合计846例。Meta分析结果显示:1有效性:与对照组相比,关节腔注射TXA可以减少TKA术后血红蛋白(Hb)的丢失量[SMD=-0.63,95%CI(-0.81,-0.45),P<0.000 01]及降低术后输血率[RR=0.28,95%CI(0.20,0.38),P<0.000 01];2安全性:与对照组相比,关节腔注射TXA不增加术后发生深静脉血栓(DVT)的风险[RR=0.66,95%CI(0.24,1.84),P=0.43]。结论当前证据表明,TKA术中关节腔注射TXA能有效减少术后失血量,且不增加术后发生DVT的风险,具有良好的临床应用价值。更多还原

【Abstract】 Objective To systematically evaluate the efficacy and safety of intra-articular injection of tranexamic acid(TXA)in patients undergoing total knee arthroplasty(TKA). Methods We electronically searched Pub Med, Cochrane Library,EMBASE, CNKI, CBM and Wanfang Data from inception to May 2014 and manually searched journal of library collection to identify randomized controlled trial(RCT) and Quasi-randomized controlled trial(q RCT) about intra-articular injection of tranexamic acid in patients undergoing TKA. The methodological quality of the included trials was assessed and the data were extracted according to the Cochrane Handbook 5.1.0. Meta-analysis. Data were analysed using Rev Man 5.2 software. Results A total of nine RCTs and one q RCT involving 846 patients were included. The results of meta-analyses showed that: 1Efficacy: Compared with the control group, the use of tranexamic acid reduced postoperative hemoglobin loss[SMD=-0.63,95%CI(-0.81,-0.45),P <0.000 01] and the rate of blood transfusion use[RR =0.28,95%CI(0.20,0.38),P <0.000 01]. 2Safety:Compared with the control group, the use of tranexamic acid did not increase the incidence of deep vein thrombosis [ RR =0.66,95%CI(0.24,1.84),P =0.43]. Conclusion The current evidence indicated that intra-articular tranexamic acid injection during total knee arthroplasty can effectively reduce postoperative hemoglobin loss and rate of blood transfusion use, without increase of the incidence of DVT. So intra-articular tranexamic acid injection has good clinical application value.更多还原