二尖瓣狭窄合并小左心室患者二尖瓣置换术后左心室形态及收缩功能变化的系统评价与Meta分析  

Changes of Left Ventricular Morphology and Contractile Function of Patients with Mitral Stenosis and Small Let Ventricle after Mitral Valve Replacement:A Systematic Review and Meta-analysis

作　　者：乔韡华 刘鹏[1] 史嘉玮[1] 王寅[1] 董念国[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2016年第6期589-594,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家"十二五"科技支撑计划项目(2011BAI11B19)~~

摘　　要：目的探讨二尖瓣狭窄合并小左心室患者二尖瓣置换术后左心室形态及收缩功能的变化情况。方法制定原始文献的纳入标准及检索策略,全面检索万方数据库、维普中文科技期刊数据库和中国期刊全文数据库以及Pub Med、Elsevier Science Direct和Cochrane Library数据库,检索时间为每个数据库建库至2015年1月,同时辅以文献追溯法以尽可能获取全部有关二尖瓣狭窄合并小左心室患者二尖瓣置换术后心脏形态及功能变化的研究,剔除不符合要求的文献后,提取相关数据并应用Meta分析方法对纳入研究的结果进行定量合并,以术前和术后左心室舒张期末容积指数(LVEDVI)、左心室舒张期末内径(LVEDD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)的均数差(MD)为效应指标,计算各研究及合并数据在手术前后的变化及其95%CI,统计学分析采用R2.15.3软件。结果最终纳入Meta分析的文献共8篇,均为高质量中文文献,累计总病例数为446例。Meta分析结果显示:相比术前,术后2周内LVEDVI升高14.51 ml/m2[95%CI(-22.78,-6.25),P<0.01],LVEDD升高4.88 mm[95%CI(-10.85,1.09),P=0.11],LVEF下降3.05%[95%CI(-3.02%,9.12%),P=0.32],LVFS升高1.16%[95%CI(-4.83%,2.50%),P=0.53];与术前相比,术后半年时LVEDVI术前升高16.11 ml/m2[95%CI(-20.32,-11.90),P<0.01],LVEDD升高10.56 mm[95%CI(-11.52,-9.60),P<0.01],LVEF升高7.69%[95%CI(-17.18%,1.80%),P=0.11],LVFS升高6.21%[95%CI(-10.07%,-2.36%),P<0.01]。结论二尖瓣狭窄合并小左心室患者二尖瓣置换术后左心室形态及收缩功能恢复良好。Objective To evaluate the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement. Methods Studies on the changes of left ventricular morphology and contractile function of patients with mitral stenosis and small left ventricle after mitral valve replacement were searched from the databases of Wangfang,VIP,CNKI,Pub Med,Elsevier Science Direct,and Cochrane Library from establishment to January 2015. Quality of articles was evaluated. Relevant data were extracted from eligible studies to conduct meta-analysis. Mean differences（MD） of left ventricle end-diastolic volume index（LVEDVI）,left ventricle end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF） and left ventricular fraction shortening（LVFS） between the preoperative and the postoperative value from eligible studies were analyzed and pooled,and their 95% confidence intervals（CI） were calculated. R2.15.3 software was applied for statistical analysis. Results Eight eligible studies involving 446 patients were analyzed in the study. The quality of included literature was high. The results of meta-analysis showed that LVEDVI and LVEDD increased by 14.51 ml/m2 with 95%CI-22.78 to-6.25（P〈0.01） and 4.88 mm with 95%CI-10.85 to 1.09（P=0.11） respectively at 2 weeks postoperatively compared with preoperative value. LVEF decreased by 3.05% with 95%CI-3.02% to 9.12%（P=0.32） while LVFS increased by 1.16% with 95%CI-4.83% to 2.50%（P=0.53） at 2 weeks postoperatively. Compared with preoperative value,LVEDVI and LVEDD markedly increased by 16.11 ml/m2 with 95%CI-20.32 to-11.90（P〈0.01） and 10.56 mm with 95%CI-11.52 to-9.60（P0.01） respectively at 6 months postoperatively. LVEF and LVFS increased by 7.69% with 95%CI-17.18% to 1.8%（P=0.11） and 6.21% with 95%CI-10.07% to-2.36%（P〈0.01） respectively at 6 months postoperatively compared with preoperative value. Conclusion Left ventricular morphology and contractil

关 键 词：二尖瓣狭窄 小左心室 二尖瓣置换术 疗效 系统评价/META分析 

分 类 号：R654.2[医药卫生—外科学]