不接触技术对冠状动脉旁路移植术后血管通畅度影响的系统评价与Meta分析  

Effect of no-touch technique in coronary artery bypass grafting's vascular patency: A systematic review and meta-analysis

作　　者：周小宇[1] 郭炯[1] 黄辰[1] 舒礼良[1] 徐敬[1] ZHOU Xiaoyu;GUO Jiong;HUANG Chen;SHU Liliang;XU Jing(The Third Department of Cardiac Surgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450000,P.R.China)

机构地区：[1]郑州大学第一附属医院心外三科,郑州450000

出　　处：《中国胸心血管外科临床杂志》2018年第12期1032-1037,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金青年科学基金项目(81700236)

摘　　要：目的评价采用不接触技术与传统技术行冠状动脉旁路移植术(CABG)术后血管通畅度的差异。方法检索1997年1月至2017年11月发表在PubMed、Cochrane Library、中国期刊全文数据库、万方数据库等有关不接触技术与传统技术对比的相关文献。采用Jadad评分进行文献质量评价。应用RevMan 5.0软件进行Meta分析。结果共纳入6个随机对照研究,Jadad评分均为5分。Meta分析结果显示,两组术后死亡(1个月内)差异无统计学意义[RR=0.68,95%CI(0.11,4.11),P=0.67]。两组术后腿部愈合不良差异无统计学意义[RR=1.46,95%CI(0.23,9.16),P=0.68]。两组短期心源性死亡(12～18个月)差异无统计学意义[RR=0.33,95%CI(0.10,1.03),P=0.06],长期心源性死亡(6～8年)差异有统计学意义[RR=0.36,95%CI(0.16,0.79),P=0.01]。不接触技术组短期(12～18个月)随访通畅率较传统技术组更高,差异有统计学意义[MD=2.64,95%CI(1.81,3.85),P<0.01]。不接触技术组长期(6～8年)通畅率较传统技术组更高,差异具有统计学意义[MD=3.08,95%CI(1.58,5.99),P<0.01]。结论在CABG中,不接触技术取材大隐静脉较传统技术相比可以提高长期存活率,可以提高患者冠状动脉桥血管的短期、长期通畅率。Objective To analyze the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting.MethodsWe searched the literatures on no-touch technique versus traditional technique in drawing great saphenous vein during coronary artery bypass grafting in PubMed, Cochrane Library,Chinese Journal Full-text Database,Wanfang database between January 1997 and November 2017. Jadad scale was used for quality verification.RevMan5.0was used for analysis.ResultsSix studies were included.Jadad scale for both6randomized controlled trials was5points.Meta-analysis showed that there was no statistical difference in postoperative mortality between the two groups with RR=0.68 and 95%CI0.11 to4.11(P=0.67).There was no statistical difference in leg wounds with RR=1.46 and 95%CI0.23to9.16(P=0.68).There was no statistical difference in short-term cardiogenic death with RR=0.33,95%CI0.10to1.03(P=0.06).The no-touch group's long-term cardiogenic death was significantly lower than the traditional group with RR=0.36,95%CI0.16to0.79(P=0.01).Postoperative no-touch group's short-term patency rate was significantly better than that of the traditional group with MD=3.08and95%CI1.58to5.99 (P<0.01).The long-term patency rate in the no-touch group was also higher than that of the traditional group with MD=3.08and95%CI1.58to5.99(P<0.01).ConclusionCompared with the traditional group,the no-touch group increases postoperative long-term survival rate,short-term and long-term patency rate.

关 键 词：大隐静脉 冠状动脉旁路移植术 不接触技术 系统评价/META分析 

分 类 号：R654.2[医药卫生—外科学]