一站式杂交技术与非体外循环下冠脉搭桥术治疗复杂冠心病的meta分析  

Meta-analysis of one-stop hybrid coronary artery revascularization versus off-pump coronary artery bypass in coronary artery disease

作　　者：马建赢 李金[1] 杨崛圣[1] 项海燕[1] 刘晨[1] 唐燕华[1] 

机构地区：[1]南昌大学第二附属医院心胸外科,江西南昌330006

出　　处：《中国老年学杂志》2016年第9期2089-2094,共6页Chinese Journal of Gerontology

基　　金：国家自然科学基金资助项目(No.81160019)

摘　　要：目的用meta分析方法对一站式杂交技术与非体外循环下冠脉搭桥术治疗冠心病疗效的临床研究进行综合性定量研究。方法使用Cochrane系统评价方法,计算机检索EMBASE,Cochrane图书馆、中国知网、万方数据库、CBM,web of Science,scopus,Google scholar and Controlled Trails metaRegister,Pubmed及Medline等数据库的文献,收集有关比较一站式杂交技术和非体外循环下冠脉搭桥术治疗冠心病的对照研究实验,评价入选研究的质量。结果共纳入符合标准的文献5篇,共409例患者。Meta分析结果显示:杂交组手术时间长于传统组住院费用多于传统组(P<0.05);机械通气时间、住ICU的时间住院时间失血量、输红细胞悬浮液量术后心肌梗死发生率明显低于传统组(P<0.05)。杂交组的非计划再次手术、术后新发房颤发生率及随访期死亡发生率与传统组无统计学差异(P>0.05),但是杂交组随访期主要心脏不良事件发生率低于传统组且重返工作或正常活动时间短于传统组(P<0.05)。结论一站式杂交治疗复杂冠心病的疗效可能优于非体外循环下冠脉搭桥术。Objective To systematically assess the clinical efficacy of hybrid coronary artery revascularization（ HCR） versus offpump coronary artery bypass（ OPCAB） in coronary artery disease. Methods Electronic databases MEDLINE,EMBASE,Cochrane Library,CNKI,CBM,VIP,Wan Fang Data were used to search for randomized controlled trials（ RCTs） or controlled clinica trials（ CCTs） reported before August 2015 on clinical effects of HCR versus OPCAB in coronary artery disease. After data were extracted,meta-analysis was performed using Rev Man 5. 3 software. Results Five literatures with 409 patients were retrieved,including 5 CCTs. Compared with OPCAB group,one-stop HCR group had longer operation time（ WMD = 1. 38,95% CI： 0. 03 ~ 2. 74,P 0. 05）,lower mechanical ventilation time（ WMD =- 9. 95,95% CI：- 18. 85 ^- 1. 31,P 0. 05）,lower ICU time（ WMD =- 25. 77,95% CI：- 33. 07 ^- 18. 46,P 0. 05）,less blood loss（ WMD =- 561. 36,95% CI：- 804. 59 ^- 318. 13,P 0. 05）,lower amount of red blood cell transfusion（ WMD =- 6.84,95% CI：- 11. 99 ^- 1. 70,P 0. 05）,less Length of hospital stay（ WMD =- 2. 33,95% CI：- 2. 89 ^- 1. 77,P 0. 05）,but higher hospital costs（ WMD = 3 622. 85,95% CI： 2 755. 01 ~ 4 490. 69,P 0. 05）,in addition,one-stop HCR group had lower incidence of myocardial infarction（ OR = 0. 17,95% CI： 0. 05 ~ 0. 61,P 0. 05）,lower incidence of MACE（ OR = 0. 15,95% CI： 0. 04 ~ 0. 59,P 0. 05）,shorter times to return to work and / or normal activity（ SMD =- 0. 84,95% CI：- 1. 27 ^- 0. 42,P 0. 05）. However,there were no statistical differences between the two groups in reoperation,new postoperative atrial fibrillation,follow-up mortality rate（ P 0. 05）. Conclusions One-stop HCR is superior to OPCAB in ICU time,hospital time,blood loss,mechanical ventilation time,amount of red blood cell transfusion,incidence of myocardial infarction,incidence of MACE,times to return to work and / or normal activity.

关 键 词：一站式杂交技术 非体外循环冠状动脉搭桥术 冠状动脉介入 微创手术 冠心病 

分 类 号：R54[医药卫生—心血管疾病]