摘要
目的评估血栓弹力图(TEG)与常规实验室检测指导心脏手术输血的有效性及预后效果。方法计算机检索万方数据、中国生物医学文献数据库(CBM)、维普、中国知网(CNKI)、Cochrane Library、PubMed、EMBASE、OVID和Web of Science等国内外数据库,收集应用TEG指导心脏手术输血的随机对照试验(RCT),应用Cochrane协作网提供的"偏倚风险评估"工具和"Jadad量表",对收集的文献进行偏倚风险和质量评估,并采用RevMan5.3软件进行Meta分析。结果最终共有9篇文献纳入研究,共计846例患者。TEG指导输血与常规输血对心脏手术死亡率的影响差异无统计学意义(3.28%vs.7.01%,P=0.06)。与常规输血比较,TEG指导输血能明显减少围术期患者的出血量[WMD=-129.24,95%CI(-249.23,-9.25),P=0.03],降低围术期浓缩红细胞的使用率[RR=0.83,95%CI(0.74,0.94),P=0.03],减少围术期新鲜冰冻血浆的使用量[WMD=-355.49,95%CI(-604.60,-106.38),P<0.01]。结论应用TEG指导心脏手术输血能显著减少围术期出血量及各种血液制品的使用量,但对患者预后有显著影响。
Objective To evaluate the validity and prognostic effect of thromboelastography（TEG）and conventional laboratory tests guided cardiac surgery blood transfusion.Methods The domestic and abroad databases of WanFang Data,VIP,CBM,CNKI,Cochrane Library,PubMed,EMBASE,OVID and Web of Science were retrieved by computer.The randomized controlled trials（RCTs）on TEG guided cardiac surgery blood transfusion were collected.The tool of Bias Risk Assessment and Jadad Scale provided by the Cochrane Collaboration network were used to conduct the bias risk and quality assessment on collected literature.The RevMan 5.3 software was adopted to conduct the meta analysis.Results Nine articles were finally included in this research,including 846 patients.The difference between TEG guided blood transfusion and conventional blood transfusion on the mortality rate of cardiac operation had no statistical significance（3.28%vs.7.01%,P=0.06）.Compared with conventional blood transfusion,the TEG guided blood transfusion could significantly decrease the bleeding volume of perioperative patients[WMD=-129.24,95%CI（-249.23,-9.25）,P=0.03],decreased the use rate of perioperative PRBC[RR=0.83,95%CI（0.74,0.94）,P=0.03]and reduced perioperative FFP use amount[WMD=-355.49,95%CI（-604.60,-106.38）,P〈0.01].Conclusion Application of TEG guided cardiac surgery blood transfusion can significantly reduce the perioperative bleeding amount and use amount of various blood products,and has obvious impact on the prognosis of patients.
作者
施婷
蒋远萍
李文桃
SHI Ting;JIANG Yuanping;LI Wentao(Department of Blood Transfusion ,Affiliated Yongchuan Hospital,Chongqing Medical University,Chongqing 400038,China;Department of Gastrointestinal Surgery,Jianyang Municipal People＇s Hospital,Chengdu,Sichuan 610000,China)
出处
《重庆医学》
CAS
2018年第19期2581-2585,共5页
Chongqing medicine
