Br J Clin Pharmacol:哪些因素决定外用氨甲环酸治疗全膝关节置换术后出血的疗效?

2017-08-09 选题审校:易湛苗 编辑:吴星 环球医学

2017年7月,发表在《Br J Clin Pharmacol》的一项由中国科学家进行的研究考察了外用氨甲环酸治疗全膝关节置换术后出血的量化疗效。

2017年7月,发表在《Br J Clin Pharmacol》的一项由中国科学家进行的研究考察了外用氨甲环酸治疗全膝关节置换术后出血的量化疗效。

目的:氨甲环酸(TXA)外用可用于行全膝关节置换术患者,减少围手术期失血。然而,最佳的剂量方案仍未确定。本研究的目的是量化评价外用TXA对于减少术后引流的影响,并确定影响外用TXA疗效的剂量方案因素。

方法:使用基于模型的荟萃分析(MBMA)评价外用TXA的疗效和影响临床疗效的剂量方案因素。确定系统文献检索的数据,用于建立一个安慰剂和TXA治疗围手术期失血的时间-影响模型。

结果:MBMA模型纳入14项包含引流量数据的16个TXA-对照组的研究。模型充分描述了术后引流-时间特征。根据模型估算,TXA能将术后引流最终降低约41.7%,且达到最大引流量的50%需要10.9 h。协变量分析显示,剂量和接触时间作为单一因素,与临床疗效不相关。但是,联合考虑时,二者能够极大改善数据的拟合。模拟显示,大量增加剂量或接触时间会产生平台效应。2~3 g TXA和1~2 h的接触时间能使引流量降低超过60%。

结论:剂量和接触时间一起能确定TXA的疗效。大剂量或长时间接触似乎是不必要的。这些发现将进一步指导外用TXA方案优化的临床实践。

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    2018-03-17 yxch48
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time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576565, encodeId=044c15e65658a, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Aug 11 07:18:00 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-09-22 yb6560
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encryptionId=fa03141591e, topicName=Pharm)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Thu Aug 10 01:18:00 CST 2017, time=2017-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1908296, encodeId=a7bb190829612, content=<a href='/topic/show?id=a8d0141605e' target=_blank style='color:#2F92EE;'>#pharma#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14160, encryptionId=a8d0141605e, topicName=pharma)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f634250, createdName=chentianping, createdTime=Sun Oct 15 14:18:00 CST 2017, time=2017-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1754175, encodeId=cb061e5417546, content=<a href='/topic/show?id=7d3330135ac' target=_blank style='color:#2F92EE;'>#关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30135, encryptionId=7d3330135ac, topicName=关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=050736663344, createdName=apoenzyme, createdTime=Mon Dec 25 12:18:00 CST 2017, time=2017-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1305959, encodeId=9160130595979, content=<a href='/topic/show?id=6a96296444d' target=_blank style='color:#2F92EE;'>#全膝关节置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=29644, encryptionId=6a96296444d, topicName=全膝关节置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e2c339, createdName=by2009, createdTime=Fri Aug 11 07:18:00 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390093, encodeId=ca1c139009366, content=<a 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time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576565, encodeId=044c15e65658a, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Aug 11 07:18:00 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-10 jj000001
  5. 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time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576565, encodeId=044c15e65658a, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Fri Aug 11 07:18:00 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
  6. 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  7. 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氨甲环酸降低了接受心脏手术患者的出血风险,但目前尚不清楚这是否会改善患者的预后。此外,人们还担忧氨甲环酸可能会有促血栓形成和致痫作用。在该项2×2析因设计的试验中,研究人员随机分配预计接受冠状动脉手术并且有围手术期并发症风险的患者接受阿司匹林或安慰剂,氨甲环酸或安慰剂。研究人员还报告了氨甲环酸比较的结果。主要结果是手术后30天内的死亡和血栓性并发症(非致死性心肌梗死,卒中,肺栓塞,肾衰竭或肠梗塞)

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已知氨甲环酸可减少全髋关节置换术围手术期失血。采用随机对照试验研究设计,共纳入了139名患者,分别接受2 g氨甲环酸局部应用或静脉注射。标准化术前和术后的方案。结果,与局部应用组患者相比 (160.3 [g] ± 63.8, 188.4 [g] ± 68.5; P = .014),静脉注射组患者血液和血红蛋白的损失量较低(1195.0 ± 485.9 mL, 1442.7 ± 562.7 mL;

BMJ:氨甲环酸有助减少手术输血需求 可缓解血荒现象

“血荒”有时会给医疗机构带来麻烦,英国的一项新研究显示,使用止血药——氨甲环酸可显著减少手术的输血需求,这或许有助缓解“血荒”现象。 英国伦敦卫生与热带医学院的研究人员在新一期《英国医学杂志》上发表报告说,他们对氨甲环酸与输血需求之间的关系进行了大量综合分析,并对比手术中使用这种药物与未使用该药的临床表现。结果显示,如果给需要手术的病人使用氨甲环酸,可使他们的输血需求平均降低约三分之一。 研究

JBJS:关节内应用氨甲环酸可减少全膝术后失血

接受全膝关节置换(TKA)的患者中大约有1/3在术后需要输血1-3个单位,氨甲环酸是一种人工合成的抗纤维蛋白溶解的药物,可以经静脉有效的控制TKA术后失血。而局部使用氨甲环酸更加便于临床管理,可以使其在出血部位形成最大的药物浓度,减少甚至消除药物全身吸收所带来的风险。 为了研究局部(关节内)应用氨甲环酸对单侧TKA输血和失血带来的影响,来自英国James Cook大学