傳明酸 (Transamine) 在咳血之應用:隨機對照試驗的系統性文獻回顧與統合分析Application of Transamine in expectoration of blood: a systematic review and meta-analysis of randomized controlled trials

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2019-08-31 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

蔡宜珊 徐莉雯* 劉秋芬 康以諾 陳可欣

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

胸腔暨重症加護醫學 Pulmonary and Critical Care Medicine

科別

  • 進階實務 Advanced Practice
  • 肺/胸腔護理 Pulmonary Nursing
  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

咳血 血痰 傳明酸 系統性文獻回顧 統合分析

英文關鍵詞

Hemoptysis Expectoration of blood tranexamic acid systematic review meta-analysis

機構名稱

臺北市立萬芳醫院-委託財團法人臺北醫學大學辦理

申請單位

護理部

中文摘要

形成臨床提問:
咳血 (expectoration of blood) 是不同肺部疾病的常見症狀,常見的咳血的主要原因包含支氣管擴張、惡性肺腫瘤、支氣管炎和肺炎,約占所有肺部疾病的20%。咳血量的增加會造成呼吸短促並導致更高的死亡率。咳血對於臨床人員而言並非容易處理的狀況。臨床上常見的咳血處置可分為外科手術與內科治療兩大類,而傳明酸 (Tranexamic acid, TXA) 就是一種常用的抗纖維蛋白溶解劑,已被證明可控制月經出血、產後出血、創傷、手術、牙齦出血等(Gagnon, Quigley, Dutau, Delage, & Fortin, 2017),然而,直接使用對肺出血的影響及其不適反應較少被討論。本研究的目的是探討使用傳明酸減少咳血病人的止血成功率及降低住院天數成效。
文獻搜尋的方法與分析:
本研究以的「傳明酸」及「咳血」作為關鍵字,採用自然語言 (free-text) 及醫學主題辭 (medical subject heading, MeSH) ,再運用布林邏輯,檢索考科藍圖書資料庫 (the Cochrane Library)、Embase、PubMed(包括 MEDLINE)及華藝線上圖書館 (CEPS 中文電子期刊資料庫暨平台服務),收納截至2019年8月之前的所有中英文文獻。本研究排除條件為(1) 非隨機對照臨床試驗的研究;(2) 族群小於 18 歲;(3) 動物實驗。
文獻的品質評讀:
本研究由兩位研究者獨立篩選並使用考科藍偏差風險工具 (Cochrane Risk of Bias Tool, RoB) 進行研究品質的嚴格評讀,並使用 RevMan 5.3進行資料數據的整合及分析,結果報告包含平均值、風險比 (RR) 、95% 信賴區間及異質性分析 (I-square)。搜尋結果包含447篇研究文章,經兩位研究者篩選後,最終納入4篇隨機對照實驗 (共185位咳血病人)。統合分析結果顯示,相對於對照組,傳明酸有較佳的止血成功率(n = 117; RR = 1.36; 95% CI 0.86至1.86; I²=77),住院時間縮短(n = 133,MD = -1.62; 95%CI -2.93至-0.31; I²= 0%)。
結論與建議:
統合分析結果顯示,傳明酸組的病人止血成功率較對照組高,住院時間也比對照組的病人短,然而,本研究所納入的研究數較少、且樣本數較小,期待未來能有進一步大規模隨機對照試驗,以確認傳明酸的有效性及給予的最佳治療策略。

英文摘要

Ask an answerable question (PICO):
Expectoration of blood, a common symptom of different lung disease, increases short of breath and results in higher mortality rate. Transamine was a commonly used anti-fibrinolytic agent, has been shown to control bleeding. However, the effects of direct use on pulmonary hemorrhage and the effect is less discussed. The purpose of this study was to investigate the use of transamine to reduce the hospital length of stay and resolution of expectoration of blood in adult patients.
The Method and Analysis of Literature Review:
Our study searched the Cochrane library, Embase, PubMed (including MEDLINE), and the CEPS for randomized clinical trials (RCTs) investigating the effects of transamineon hemoptysis before August 2019. We focused on literature in Chinese and English and followed reference lists for identifying relevant trials.
Critical Appraisal:
Two of us individually assessed the study quality by using the Cochrane Risk of Bias (RoB) tool, and pooled results were estimated in the RevMan 5.3 software.Our search identified 447 references, and 4 of them met eligible criteria. The four RCTs recruited 185 patients with hemoptysis. The pooled result showed that no significant differences in resolution expectoration of blood (n=117, Risk Ratio [RR] = 1.36; 95% CI 0.86 to 1.86; I²= 77%) between transaminegroup and control group. However, the pooled estimate showed that transaminedecreased hospital length of stay (n=133, MD = -1.62; 95% CI -2.93 to -0.31; I²= 0%).
Conclusions and Recommendations:
Our meta-analysis indicated that transaminehas shorter hospital length of stay among patients with expectoration of blood. Nevertheless, our evidence involved small sample size trials. We anticipate further large scale RCTs to confirm the effectiveness and safety of transamine.