糖皮质激素对心脏手术保护作用的Meta分析  

Protective Effects of Corticosteroids on Heart Surgery:A Meta Analysis

作　　者：刘欢[1] 王志维[1] 张遵严[1] 陈雪芬[1] 吴红兵[1] 

机构地区：[1]武汉大学人民医院心血管外科,武汉430060

出　　处：《医学综述》2013年第5期922-926,共5页Medical Recapitulate

摘　　要：目的评价在心脏手术中应用糖皮质激素对降低术后并发症的发病率和病死率方面的作用。方法计算机检索PubMed和Cochrane从1990～2012年的数据,在104个系统双盲试验中选取10个适合的作Meta分析。Meta分析采用Cochrane协作网提供的RevMan5.1软件进行。结果糖皮质激素的抗炎作用一定程度地避免了心脏手术患者术后心房颤动的发生(OR=0.64,95%CI 0.47～0.88,P=0.005),减少了患者手术后机械通气时间(MD=0.24,95%CI 0.05～0.43,P=0.01),减少了重症监护时间(MD=-1.95,95%CI-2.89～-1.00,P<0.01),及住院时间(MD=-1.43,95%CI-2.01～-0.85,P<0.01)。但糖皮质激素的使用不能降低术后患者的病死率(OR=0.57,95%CI 0.22～1.47,P=0.25)及渗血量和术后感染。结论此系统双盲试验反映了糖皮质激素的抗炎性反应作用在心脏手术中的运用可能降低患者术后并发症的发病率,并且不会增加感染的风险。Objective To evaluate the effects of steroid treatment on reducing mortality and complication after cardiac surgery.Methods A trial search was performed through PubMed and Cochrane databases from 1990 to 2012.Among 104 clinical trials reviewed,10 Double-Blind trials were considered suitable to be analyzed.Meta analysis was done with RevMan5.1 provided by Cochrane network.Results Steroid prophylaxis provided a protective effect preventing postoperative atrial brillation（OR=0.64,95%CI 0.47-0.88,P=0.005）,reducing ventilation duration（MD=0.24 h,95% CI 0.05-0.43,P=0.01）,and reducing intensive care unit（MD=-1.95 h,95% CI-2.89——1.00 h,P0.01） and overall hospital stay（mean difference=-1.43 days;95% CI-2.01——0.85 days,P0.01）.Steroid prophylaxis had no effect on postoperative mortality（OR=0.57,95% CI 0.22-1.47,P=0.25）,blood loss,and postoperative infection.Conclusion A systematic review of RDB trials reveals that steroid prophylaxismay may reduce complications after cardiac surgery and does not increase the risk of postoperative infections.

关 键 词：体外循环 炎性反应 并发症 心房颤动 感染 

分 类 号：R654.1[医药卫生—外科学]