目的:系统评价氨甲环酸和ε-氨基己酸在全髋关节置换术(THA)和全膝关节置换术(TKA)中的止血效果。
方法:关于氨甲环酸和ε-氨基己酸用于比较THA或TKA的随机对照试验(RCT)和回顾性病例对照研究在PubMed中进行了电子搜索,EMBase,科克伦图书馆,中国国家知识基础设施(CNKI),万方,从建立数据库到2020年7月的VIP。两名研究者分别按照纳入和排除标准进行文献筛选和数据提取。通过Cochrane手册对纳入的随机对照研究的方法学质量进行了评价。通过NOS量表评价纳入的回顾性病例对照研究的方法学质量。失血,血栓并发症的发生率,采用ReviewManager5.3软件对人均血红蛋白输入进行Meta分析。
结果:共纳入6篇,包括4项RCT和2项回顾性病例对照研究。共有3174名患者,包括氨甲环酸组1353和ε-氨基己酸组1821。Meta分析结果显示,两组患者失血量差异无统计学意义[MD=-88.60,95CI(-260.30,83.10),P=0.31],输血率[OR=1.48,95CI(0.96,2.27),P=0.08],血栓性并发症[OR=0.80,95CI(0.07,8.83),P=0.85],人均血红蛋白输入[MD=0.04,95CI(-0.02,0.10),在THA期间,氨甲环酸组和ε-氨基己酸组之间的P=0.18]。在TKA,氨甲环酸组的失血量小于ε-氨基己酸组[MD=-147.13,95CI(-216.52,-77.74),P<0.0001],差异有统计学意义。输血率[OR=1.30,95CI(0.74,2.28),P=0.37],血栓性并发症[OR=0.95,95CI(0.38,2.36),P=0.92],人均血红蛋白输入[MD=-0.00,95CI(-0.05,0.06),P=0.48],止血带时间[MD=1.54,95CI(-2.07,5.14),P=0.40]两组间相似,差异无统计学意义。
结论:在THA中,氨甲环酸和ε-氨基己酸具有相似的止血作用,在TKA,氨甲环酸能有效减少患者的失血量,具有较好的止血效果。氨甲环酸被推荐为TKA的首选止血药物之一。
OBJECTIVE: To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA).
METHODS: Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library,
China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software.
RESULTS: A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [MD=-88.60, 95%CI(-260.30, 83.10), P=0.31], blood transfusion rate [OR=1.48, 95%CI(0.96, 2.27), P=0.08], thrombotic complications [OR=0.80, 95%CI(0.07, 8.83), P=0.85], per capita hemoglobin input [MD=0.04, 95%CI(-0.02, 0.10), P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [MD=-147.13, 95%CI(-216.52, -77.74), P<0.0001], the difference was statistically significant. The blood transfusion rate [OR=1.30, 95%CI(0.74, 2.28), P=0.37], thrombotic complications [OR=0.95, 95%CI(0.38, 2.36), P=0.92], per capita hemoglobin input [MD=-0.00, 95%CI(-0.05, 0.06), P=0.48], tourniquet time [MD=1.54, 95%CI(-2.07, 5.14), P=0.40] were similar between two groups, the difference was not statistically significant.
CONCLUSIONS: In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient\'s blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.