目的:我们旨在通过系统评价和荟萃分析评估局部氨甲环酸(TXA)与局部血管收缩剂治疗鼻出血的有效性。
方法:荟萃分析遵循系统评价和荟萃分析(PRISMA)标准的首选报告项目。我们系统地搜索了Embase,WebofScience,科克伦图书馆,CNKI,和PubMed用于随机对照试验(从开始到2022年8月;没有语言限制),比较局部TXA和局部血管收缩剂治疗鼻出血的效果。Q检验用于评估异质性,和漏斗图用于识别偏倚。对于荟萃分析,采用了固定效应模型,t检验用于确定显著性。
结果:在1012项确定的研究中,5个被发现有资格接受我们的分析。总的来说,包括598例患者;其中297例接受TXA,301例接受血管收缩剂。在接受TXA治疗的患者中,首次重新评估时更有可能实现止血。亚组分析显示,接受TXA治疗的患者出血复发的可能性较小。与使用血管收缩剂治疗的患者相比。检测到的再出血时间间隔为10分钟,在24h到72h之间,7天后,分别,用TXA和血管收缩药治疗的两组患者之间差异有统计学意义。
结论:在治疗鼻出血时,与局部血管收缩药相比,局部TXA与更好的治疗后失血性停滞率相关。
We aimed to evaluate the effectiveness of topical tranexamic acid (TXA) versus topical
vasoconstrictors in the management of epistaxis via a systematic review and meta-analysis.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were followed for the meta-analysis. We systematically searched Embase, Web of Science, Cochrane Library, CNKI, and PubMed for randomized controlled trials (from inception to August 2022; no language restrictions), comparing the effect of topical TXA and topical
vasoconstrictors on the treatment of epistaxis. The Q test was used to evaluate heterogeneity, and funnel plots were utilized to identify bias. For the meta-analysis, the fixedeffects model was employed, and the t-test was utilized to determine significance.
Of 1012 identified studies, 5 were found to be eligible for our analysis. In total, 598 patients were included; 297 of them received TXA and 301 received
vasoconstrictors. Hemostasis was more likely to be achieved at the first re-assessment in patients treated with TXA. Subgroup analysis indicated patients treated with TXA to have less likelihood of bleeding recurrence, compared to patients treated with
vasoconstrictors. The detected time interval of rebleeding was 10 min, between 24 h to 72 h, and after 7 days, respectively, and the differences were significant between the two groups of patients treated with TXA and vasoconstrictors.
Topical TXA was associated with better post-treatment hemorrhagic arrest rates compared to topical
vasoconstrictors in the management of epistaxis.