Page 81 - 《中国药房》2023年21期

·循证药学·

3 种蛇毒血凝酶类药物用于腹部手术止血有效性和安全性的网
状Meta分析
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郑子恢 ，潘慧杰 ，赵紫楠 ，胡 欣 ，金鹏飞 [1.北京医院药学部/国家老年医学中心/中国医学科学院老年医
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学研究院/北京市药物临床风险与个体化应用评价重点实验室（北京医院），北京 100730；2.北京医院检验科/
国家老年医学中心/中国医学科学院老年医学研究院，北京 100730]
中图分类号 R973+.2；R982 文献标志码 A 文章编号 1001-0408（2023）21-2631-07
DOI 10.6039/j.issn.1001-0408.2023.21.11

摘 要 目的 系统评价3种蛇毒血凝酶类药物用于腹部手术止血的效果及安全性，为临床用药提供循证依据。方法 计算机检
索Embase、Cochrane Library、PubMed、中国生物医学文献数据库、中国知网及万方数据库，收集3种蛇毒血凝酶类药物（蛇毒血凝
酶注射液、注射用矛头蝮蛇血凝酶、注射用尖吻蝮蛇血凝酶）在腹部手术的随机对照试验（RCT），检索时限均为建库至2023年8
月。按纳入排除标准对文献进行筛选、质量评价及数据提取，使用Cochrane 5.1手册进行文献质量评价。采用Stata 15.1软件绘制
风险偏倚图及网状图，应用R 3.6.2软件以及马尔科夫链-蒙特卡洛方法进行贝叶斯网状Meta分析。结果 共纳入11项研究，合计
1 401 例患者，试验组 852 例、对照组 549 例。在腹部手术止血效果方面，蛇毒血凝酶注射液明显优于注射用尖吻蝮蛇血凝酶
[MD＝－2.45，95%CI（－4.39，－0.24），P＜0.05]，减少术中出血量概率排序为蛇毒血凝酶注射液＞注射用矛头蝮蛇血凝酶＞注射
用尖吻蝮蛇血凝酶；在安全性方面，3种蛇毒血凝酶类药物与安慰剂相比差异均无统计学意义（P＞0.05）。结论 蛇毒血凝酶注射
液在腹部手术中止血效果明显优于注射用尖吻蝮蛇血凝酶，3种蛇毒血凝酶类药物安全性均良好。
关键词 蛇毒血凝酶类药物；腹部手术；止血；有效性；安全性；贝叶斯网状Meta分析

Network meta-analysis of the effectiveness and safety of 3 kinds of snake venom hemocoagulase drugs for
hemostasis in abdominal surgery
ZHENG Zihui ，PAN Huijie ，ZHAO Zinan ，HU Xin ，JIN Pengfei [1. Dept. of Pharmacy， Beijing Hospital/
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National Center for Gerontology/Institute of Geriatrics， Chinese Academy of Medical Sciences/Beijing Key
Laboratory for Clinical Risk and Individualized Application Evaluation of Drugs （Beijing Hospital）， Beijing
100730， China；2. Dept. of Laboratory， Beijing Hospital/National Center for Gerontology/Institute of Geriatrics，
Chinese Academy of Medical Sciences， Beijing 100730， China]
ABSTRACT OBJECTIVE To systematically evaluate the hemostatic effect and safety of snake venom hemocoagulase drugs in
abdominal surgery， so as to provide evidence-based evidence for clinic. METHODS Retrieved from Embase， Cochrane Library，
PubMed， China Biomedical Literature Database， CNKI and Wanfang database， randomized controlled trials （RCTs） about 3 kinds
of snake venom hemocoagulase drugs （Hemocoagulase injection， Hemocoagulase Bothrops atrox for injection， Haemocoagulase
Agkistrodon for injection） in abdominal surgery were collected from the establishment of the database to Aug. 2023. Screening，
quality evaluation， and data extraction were conducted on literature according to the inclusion and exclusion criteria， and Cochrane
5.1 was used for literature quality evaluation. The risk bias diagram and network diagram were drawn by Stata 15.1 software， and
the Bayesian network meta-analysis was carried out by using R 3.6.2 software and Markov chain-Monte Carlo method. RESULTS
A total of 11 studies were included， involving 1 401 patients， 852 in the study group， and 549 in the control group. In terms of
hemostatic effect， Hemocoagulase injection was significantly superior to Haemocoagulase Agkistrodon for injection [MD＝－2.45，
95%CI （－4.39，－0.24）， P＜0.05]， and the probability of reducing intraoperative bleeding was ranked as follows： Hemocoagulase
injection＞hemocoagulase B. atrox for injection＞Haemocoagulase Agkistrodon for injection； in terms of safety， there was no
statistically significant difference between the three snake venom hemocoagulase drugs and placebo （P＞0.05）. CONCLUSIONS
The hemostatic effect of Hemocoagulase injection in abdominal surgery is significantly better than that of Haemocoagulase
Agkistrodon for injection； all three snake venom
Δ 基金项目 国家重点研发计划项目（No.2020YFC2008305） hemocoagulase drugs have good safety.
＊第一作者 副主任药师。研究方向：医院药学、循证医学、大数据
分析。电话：010-85136729。E-mail：12686@qq.com KEYWORDS snake venom hemocoagulase； abdominal
# 通信作者 主任药师，博士生导师，博士。研究方向：医院药学、 surgery； hemostatic； effectiveness； safety； Bayesian network
药物分析。电话：010-85133620。E-mail：j790101@163.com meta-analysis

中国药房 2023年第34卷第21期 China Pharmacy 2023 Vol. 34 No. 21 · 2631 ·