目的:本系统综述和荟萃分析的随机对照试验(RCT)和回顾性对照研究(RCSs)旨在评估大剂量氨甲环酸(TXA)在青少年特发性脊柱侧凸(AIS)患者脊柱矫正手术中的有效性和安全性。
方法:2024年3月,在PubMed进行了全面搜索,WebofScience,Embase,和Cochrane数据库,以确定RCT和RCS,比较高剂量TXA对脊柱矫正手术期间失血和输血需求的影响。
结果:本荟萃分析包括10项临床试验,共741例患者。汇总结果表明,使用高剂量TXA可显着减少术中失血量[WMD=-519.83,95%CI(-724.74,-314.92),P<0.00001],输血率[RR=0.28,95%CI(0.17,0.45),P<0.00001],总失血量[WMD=-891.09,95%CI(-1623.92,-158.26),P=0.02],和术后失血[WMD=-105.91,95%CI(-141.29,-70.52),P<0.00001]。手术时间无显著差异[WMD=-18.96,95%CI(-40.20,2.28),P=0.08]和每段失血量[WMD=-50.51,95%CI(-102.19,1.17),P=0.06]。两组的血栓栓塞事件发生率相当。
结论:我们的荟萃分析表明,使用高剂量TXA减少术中失血,输血率,总失血量,和AIS患者脊柱矫正手术的术后失血。然而,手术时间和每段失血量无显著差异.
OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective controlled studies (RCSs) aims to evaluate the efficacy and safety of high-dose tranexamic acid (TXA) in spinal correction surgery for adolescent idiopathic scoliosis (AIS) patients.
METHODS: In March 2024, a comprehensive search was conducted in PubMed, Web of Science, Embase, and Cochrane databases to identify RCTs and RCSs comparing the effects of high-dose TXA on blood loss and transfusion requirements during spinal correction surgery.
RESULTS: This meta-analysis included 10 clinical trials encompassing a total of 741 patients. The pooled results indicated that the use of high-dose TXA significantly reduced intraoperative blood loss [WMD = -519.83, 95% CI (-724.74, -314.92), P < 0.00001], transfusion rate [RR = 0.28, 95% CI (0.17, 0.45), P < 0.00001], total blood loss [WMD = -891.09, 95% CI (-1623.92, -158.26), P = 0.02], and postoperative blood loss [WMD = -105.91, 95% CI (-141.29, -70.52), P < 0.00001]. There was no significant difference in operative time [WMD = -18.96, 95% CI (-40.20, 2.28), P = 0.08] and blood loss per segment [WMD = -50.51, 95% CI (-102.19, 1.17), P = 0.06]. Both groups had a comparable incidence of thromboembolic events.
CONCLUSIONS: Our meta-analysis suggests that the use of high-dose TXA reduces intraoperative blood loss, transfusion rate, total blood loss, and postoperative blood loss in spinal correction surgery for AIS patients. However, there were no significant differences in operative time and blood loss per segment.