摘要
目的:用Meta分析的方法评价止血带在全膝关节置换术中的疗效以及安全性。方法:检索MEDLINE、EMBASE、OVID和Science Direct等数据库并结合手工检索,时间从建库至2013年7月,查找有关全膝关节置换术中是否采用止血带的临床随机对照试验,采用Rev Man 5.1软件进行Meta分析。结果:使用止血带可以减少全膝关节置换术中出血量[WMD=-203.62,95%CI(-281.74,-125.49)],但会增加术后出血量[WMD=79.43,95%CI(13.40,145.45)],使用止血带并没有明显缩短手术时间[WMD=-6.36,95%CI(-13.62,0.90)],两者深静脉血栓形成及肺栓塞发生率亦没有统计学差异(均P>0.05)。结论:全膝关节置换术中是否使用止血带,对总失血量、手术时间及血栓性栓塞病的发生率没有影响。
Objective Although tourniquets are widely used in total knee arthroplasty （TKA）, the effective-ness and safety are still in controversy. We therefore conducted an updated meta-analysis to compare the out-comes of tourniquet assisted to non-tourniquet assisted TKA and provide recommendations for using tourniquet in TKA. Methods A systematic search of studies published through March 2013 was conducted using MED-LINE, EMBASE, OVID, and ScienceDirect. Randomized controlled trials （RCTs） that assessed the influence of the use of a tourniquet in TKA and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Results Fifteen studies encompassing 804 patients and comparing TKA with and without the use of a tourni-quet met the inclusion criteria. Overall, the result of meta-analysis indicated that using a tourniquet could de-crease the intraoperative blood loss [WMD=-203.62,95%CI（-281.74,-125.49）] but could increase the postopera-tive blood loss [WMD=79.43,95%CI（13.40, 145.45）]. However, there was no statistically significant difference in calculated blood loss and measured total blood loss between the tourniquet and non-tourniquet groups （P〉0.05）. There was no statistically significant difference in operation time （P〉0.05）. Patients treated with a tourni-quet might not have higher risks of thromboembolic complications, such as deep vein thrombosis and pulmonary thromboembolism （P〉0.05）. Conclusion The use of a tourniquet during TKA may be effective for reducing intraoperative blood loss, but not for reducing the postoperative blood loss and actual total blood loss. The use of a tourniquet may not be related to increased incidence of thromboembolic complications. Due to the limitations of this meta-analysis and poor quality of the evidence currently available, high-quality RCTs are required.
出处
《中国中西医结合外科杂志》
CAS
2014年第6期581-586,共6页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
基金
国家自然科学基金项目(81102607)
天津市公安局科研基金资助项目(2013KYSGAY033)
