| Ming Yang,Jinlong Liu. Safety and efficacy of acute normovolemic hemodilution during liver surgery: A meta-analysis. Oncol Transl Med, 2019, 5: 285-292. |
| meta分析：急性等容性血液稀释在肝脏手术中的应用 |
| Safety and efficacy of acute normovolemic hemodilution during liver surgery: A meta-analysis |
| Received:July 28, 2019 Revised:December 26, 2019 |
| DOI：10.1007/s10330-019-0371-1 |
| 中文关键词: 安全及有效性；急性等容性血液稀释；肝脏手术；meta分析 |
| 英文关键词: safety and efficacy; acute normovolemic hemodilution (ANH); liver surgery; meta-analysis |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Ming Yang | Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College | 263805652@qq.com | | Jinlong Liu* | Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical College | liujl800813@163.com |
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| 中文摘要: |
| 目的：系统评价急性等容性血液稀释（Acute Normovolemic Hemodilution ，ANH）预防肝脏手术中出血及输血量的临床效果。
方法：计算机检索PubMed、中国生物医学数据库、The Cochrane Library数据库。搜集有关急性等容性血液稀释应用在肝脏手术中的临床试验，检索年限为建库至2019年8月1日以前发表的相关文献，由2名研究者独立筛选文献、提取资料及评价纳入研究的风险偏倚后，采用Revmarn5.0软件进行meta分析。提取数据包括术中输血量，术中出血量，术后血细胞比容（Hct），术后凝血酶原时间（PT）以及在术中输血例数。
结果：本研究共纳入14项研究，meta分析结果显示：ANH可以降低术中输血量[MD = ?1.99，95% CI（ ?2.82，?1.16）， P < 0.0001]。ANH组术中出血量低于对照组[MD = -72.81，95％CI（-136.12，-9.50）， P ＜0.0001]，ANH组术后Hct水平低于对照组[MD = -3.38，95％CI（-7.14，-0.67），P＜0.0001]。患者的术后凝血酶原时间并不受ANH的影响[MD = -0.02，95％CI（-0.18，-0.32）， P = 0.65]。ANH组需输血的患者数明显低于对照组[OR= 0.13，95％CI（0.09-0.18），P = 0.24]。
结论：本研究通过对14篇纳入文献进行系统评价，发现ANH可以减少肝脏手术中出血量及降低输血需求量。因此，ANH可以作为一种安全有效的降低肝脏手术术中出血及输血需求的技术。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。 |
| 英文摘要: |
| Objective: The aim of this study was to evaluate the safety and efficacy of acute normovolemic
hemodilution (ANH) during liver surgery.
Methods: Structured searches of the PubMed, Chinese Biological Medicine Database, and Cochrane
Library electronic databases were performed, followed by a meta-analysis of outcomes, including
intraoperative blood transfusion(s), intraoperative bleeding, postoperative hematocrit (Hct) levels,
postoperative prothrombin time (PT), and number of patients who underwent transfusions during liver
surgery.
Results: In total, 14 eligible studies were included in the meta-analysis, which revealed that ANH for liver
resection was associated with a reduction in intraoperative blood transfusions [weighted mean difference
(WMD) ?1.99; 95% confidence interval (CI) ?2.82 to ?1.16; P < 0.00001]. The ANH group experienced
less intraoperative bleeding (WMD ?72.81; 95% CI ?136.12 to ?9.50; P < 0.00001) and exhibited a lower
postoperative Hct level (WMD ?3.38; 95% CI ?7.14 to ?0.67; P < 0.00001) than the control group. Moreover,
meta-analysis revealed that postoperative prothrombin time was not affected by ANH (WMD ?0.02; 95% CI
?0.18 to ?0.32; P = 0.65). Finally, the number of patients requiring allogeneic transfusion was significantly
smaller in the ANH group than in the control group (odds ratio 0.13; 95% CI 0.09 to 0.18; P = 0.24).
Conclusion: Results of the present meta-analysis indicated that ANH can reduce intraoperative bleeding
and the need for blood transfusions. In addition, ANH did not negatively affect the coagulation system after
surgery; therefore, ANH appears to be safe and effective during liver surgery. |
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