背景:肝病每年导致200万人死亡,占全球所有死亡人数的4%。肝脏手术是有效的治疗选择之一。出血是肝脏手术中的主要并发症。围手术期出血和异体输血可能使预后恶化。特利加压素(TP),抗利尿激素的合成类似物,可以减少腹部手术期间的失血。几个临床中心试图在肝脏手术中使用TP,但是它在减少失血和需要同种异体输血方面有效的证据,以及围手术期的安全性,尚不清楚。这项系统评价和荟萃分析的目的是评估TP在减少肝脏手术中失血和同种异体输血需求方面的有效性和安全性。
方法:我们将搜索PubMed,EMBASE,Cochrane图书馆和WebofScience从开始到2023年7月在肝脏手术中围手术期使用TP的研究。我们将语言限制为英语,两名审稿人将独立筛选和选择文章。主要研究结果是估计的失血量和同种异体输血的需要。次要结果包括手术时间,重症监护室逗留,逗留时间,术中尿量,急性肾损伤率,术后并发症,随访期间的肝肾功能,和TP相关的不良反应。我们将包括符合以下标准的研究:(1)随机对照试验(RCT),队列研究或病例对照研究;(2)发表时间为2023年7月;(3)接受择期肝脏手术的成年患者(≥18岁);(4)TP与其他治疗方法的比较;(5)研究包括至少一项结局.我们将排除动物研究,病例报告,案例系列,非原创文章,reviews,儿科文章,非对照试验,未发表的文章,非英语文章和其他重复的研究。我们将使用ReviewManagerV.5.3软件进行荟萃分析,并根据Jadad评分对随机对照试验的研究质量进行分层分析。对于队列或病例对照研究,研究质量将根据纽卡斯尔-渥太华量表评分进行分析。建议的分级,评估,开发和评估将用于评估对累积证据的信心。对于主要结果,我们将基于meta回归进行亚组分析.我们还将进行留一法敏感性分析,以评估每个单独研究对合并结果的影响,方法是逐一删除具有显着异质性的单独研究。该方案遵循Cochrane系统审查和荟萃分析方案指南的首选报告项目手册。
背景:这项研究是对现有数据的二次分析;因此,它不需要道德批准。我们将通过同行评审的出版物传播结果。
■CRD42023450333。
BACKGROUND: Liver disease causes 2 million deaths annually, accounting for 4% of all deaths worldwide. Liver surgery is one of the effective therapeutic options. Bleeding is a major complication during liver surgery. Perioperative bleeding and allogeneic blood transfusion may deteriorate the prognosis.
Terlipressin (TP), a synthetic analogue of the antidiuretic hormone, may reduceblood loss during abdominal surgery. Several clinical centres have attempted to use TP during liver surgery, but the evidence for its effectiveness in reducing blood loss and the need for allogeneic blood transfusion, as well as its safety during the perioperative period, remains unclear. The aim of this systematic
review and meta-analysis is to evaluate the efficacy and safety of TP in reducing blood loss and allogeneic blood transfusion needs during liver surgery.
METHODS: We will search PubMed, EMBASE, the Cochrane Library and Web of Science for studies on perioperative use of TP during liver surgery from inception to July 2023. We will limit the language to English, and two reviewers will independently screen and select articles. The primary study outcomes are estimated blood loss and the need for allogeneic blood transfusion. Secondary outcomes include operating time, intensive care unit stay, length of stay, intraoperative urine output, acute kidney injury rate, postoperative complications, hepatic and renal function during follow-up, and TP-related adverse effects. We will include studies that met the following criteria: (1) randomised controlled trials (RCTs), cohort studies or case-control studies; (2) the publication time was till July 2023; (3) adult patients (≥18 years old) undergoing elective liver surgery; (4) comparison of TP with other treatments and (5) the study includes at least one outcome. We will exclude animal studies, case reports, case series, non-original articles, reviews, paediatric articles, non-controlled trials, unpublished articles, non-English articles and other studies that are duplicates. We will use
Review Manager V.5.3 software for meta-analysis and perform stratification analysis for the study quality of RCTs based on the Jadad score. For cohort or case-control studies, the study quality will be analysed based on Newcastle-Ottawa Scale scores. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. For primary outcomes, we will conduct subgroup analyses based on meta-regression. We will also perform leave-one-out sensitivity analyses to evaluate the effect of each individual study on the combined results by removing the individual studies one by one for outcomes with significant heterogeneity. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines.
BACKGROUND: This study is a secondary analysis of existing data; therefore, it does not require ethical approval. We will disseminate the results through peer-reviewed publications.
UNASSIGNED: CRD42023450333.