顺行性脑灌注辅助下主动脉弓部手术过程中深低温、中度低温、浅低温停循环技术对手术结果的影响:Meta分析  

Effects of mild,moderate or deep hypothermic circulation arrest with antegrade cerebral perfusion in aortic arch surgery:a Meta-analysis

作　　者：裴华伟[1] 常谦[1] 田川[1] 裴振华[2] 蒙延海[1] 熊文龙[1] 

机构地区：[1]中国医学科学院 北京协和医学院 国家心血管病中心 阜外心血管病医院 心血管疾病国家重点实验室 血管外科中心,100037 [2]解放军第306医院全军口腔疾病诊治中心

出　　处：《心血管外科杂志（电子版）》2013年第4期21-25,共7页Journal of Cardiovascular Surgery(Electronic Edition)

摘　　要：目的对比顺行性脑灌注下置换主动脉弓部手术中不同温度停循环技术对手术结果的影响,为术中选择的合适温度提供依据。方法应用Pubmed、Embase、Cochrane Library数据库检索不同温度停循环联合顺行性脑灌注辅助下实施主动脉弓置换术的文章,纳人文章应报道术后结果。由两位调查者分别阅读文献并获取资料用于Meta分析。研究采用STATA 11.2进行荟萃分析,Cochrane Q检验和I2检验进行研究组间异质性检验。结果通过检索,共纳入8篇文献,每两组不同温度间结果对比均具有3篇及3篇以上文献结果用于分析。分析结果:深低温组、中度低温组术前急诊患者比例、主动脉夹层患者比例、全主动脉弓置换术比例两组没有差别(P>0.05),浅低温组相对于深低温组、中度低温组急诊患者、主动脉夹层患者、全主动脉弓置换术患者所占比例较低(P<0.05)。数据分析:三组间术后早期病死率无明显差异[OR1=0.74,95%CI(0.35,1.55),OR2=0.31,95%CI(0.06,1.50),OR3=0.83,95%CI(0.46,1.50)],术后短暂性神经功能障碍发生率三组间无明显差异[OR1=0.82,95%CI(0.43,1.56),OR2=0.68,95%CI(0.25,1.80),OR3=0.68,95%CI(0.38,1.23)],术后持续性神经功能障碍发生率三组间无明显差异[OR1=0.75,95%CI(0.16,3.45),OR2=0.20,95%CI(0.04,1.14),OR3=0.78,95%CI(0.29,2.14)]。结论在顺行性脑灌注辅助下行主动脉弓部手术过程中深低温及中度低温停循环均可提供良好的脑保护作用,浅低温在复杂性主动脉弓部手术中的应用仍有待于进一步评价。Objective To compare the postoperation outcome among different temperature for hypothermic circulation arrest with antegrade cerebral perfusion in aortic arch surgery ,to determine which temperature provides best brain protection .Methods Pubmed ,Embase and Cochrane Library were searched for studies reporting on the postoperation outcome in aortic arch replacement with different hypothermic circulation arrest with antegrade cerebral perfusion.Two principle investigators respectively extracted the information for Meta-analysis.Meta-analyses were conducted using STATA version 11.2 .Analysis of heterogeneity was performed with the Cochrane Q statistic and the I2statistics.Results 8 studies were selected to analysis ,no less than 3 studies could be used to analysis the&nbsp;result between every two different groups .Pooled analysis showed that Mild hypothermic circulation arrest ( Mild HCA) group patients had lower percentage of , emergency , aortic dissection and aortic arch replacement than the other two groups.However, there were no significant differences for mortality among Mild , Moderate and Deep hypothermic circulation arrest groups [OR1 =0.74,95% CI(0.35,1.55),OR2 =0.31,95% CI(0.06,1.50), OR3=0.83,95%CI(0.43,1.50)],similar rates of temporary neurologic dysfunction (TND)[OR1=0.82,95%CI(0.43,1.56),OR2=0.68,95% CI(0.25,1.80),OR3=0.68,95% CI(0.38,1.23)],also similar rates of permanent neurologic dysfunction(PND)[OR1=0.75,95%CI(0.16,3.45),OR2=0.20,95%CI(0.04,1.14), OR3=0.78,95% CI(0.29,2.14)].Conclusions Deep hypothermic circulation arrest (DHCA)and Moderate hypothermic circulation arrest ( Moderate HCA ) with antegrade cerebral perfusion offer effective cerebral and neurological protection,Mild hypothermic circulation arrest ( Mild HCA) may not suitable to use in complex aortic arch surgery .

关 键 词：主动脉 胸 停循环 深低温诱导 顺行性脑灌注 

分 类 号：R654.1[医药卫生—外科学]