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背景:目前,与常规负压引流比较,全膝关节置换后使用自体血回输引流的优势尚未得到明确,有待循证医学证据的进一步支持。目的:基于现有的循证医学证据,与常规负压引流比较,评价全膝关节置换中应用自体血回输引流的有效性、安全性及潜在优势。方法:系统检索PubM ed,Embase和Cochrane Library数据库,将所有在全膝关节置换中比较自体血回输引流与传统负压引流疗效的随机对照试验纳入进行Meta分析。结果与结论:共纳入随机对照试验12篇,共计1 119例患者,其中自体血回输引流556例,传统负压引流563例。Meta分析结果显示,术后使用自体血回输引流的患者与传统负压引流的患者相比,有更低的输血率(OR=0.28,95%CI:0.14-0.55,Z=3.67,P=0.000 2)和更少的平均输血单位数(WMD=-0.56,95%CI:-0.79至-0.33,Z=4.71,P<0.000 01)。两组患者在伤口并发症发生率、深静脉血栓发生率、术后发热发生率、术后第5-8天血红蛋白水平、伤口引流量和住院时间比较均差异无显著性意义(P>0.05)。结果说明,自体血回输引流可降低全膝关节置换后患者的输血率和平均输血单位数,是一种可替代传统负压引流的安全、有效的治疗手段。
BACKGROUND: At present, the advantages of using autologous blood transfusion after total knee arthroplasty have not yet been clarified compared with conventional negative pressure drainage, and further evidence-based medical support is needed. OBJECTIVE: To evaluate the efficacy, safety and potential benefits of autologous blood transfusion in total knee arthroplasty based on available evidence-based evidence compared with conventional negative pressure drainage. Methods: The PubM ed, Embase and Cochrane Library databases were searched systematically. All randomized controlled trials comparing total autotransfusion with total negative drainage in total knee arthroplasty were included in the meta-analysis. RESULTS AND CONCLUSION: A total of 12 randomized controlled trials involving 1119 patients were included. Among them, 556 cases of autologous blood transfusion and 563 cases of traditional negative pressure drainage were included. Meta-analysis showed that patients who underwent autologous blood drainage after operation had lower transfusion rates (OR = 0.28, 95% CI: 0.14-0.55, Z = 3.67, P = 0.000 2) and less mean number of units transfused (WMD = -0.56, 95% CI: -0.79 to -0.33, Z = 4.71, P <0.000 01). There was no significant difference between the two groups in the incidence of wound complications, incidence of deep venous thrombosis, incidence of postoperative fever, hemoglobin level 5-8 days after operation, wound drainage and hospital stay (P> 0.05) . The results show that autologous blood transfusion can reduce the blood transfusion rate and mean blood transfusion unit after total knee arthroplasty, which is a safe and effective alternative to traditional negative pressure drainage.