心脏停搏液灌注方式与术后心功能关系的Meta分析  

The relationship between cardioplegia delivery strategy and post-operative cardiac function:a Meta analysis

作　　者：伊利亚尔.买买提力 郭海[1] 郑宏[1] Ilyar Mamtili GUO Hai ZHENG Hong(Department of Anesthesiology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, 830054, Chin)

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《临床心血管病杂志》2016年第12期1241-1246,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金重点项目(No:U1403223)

摘　　要：目的：探讨停跳心脏手术中,顺灌与联合灌注心脏停搏液在不同心脏疾病与手术应用中的优劣,为指导临床个体化选择停搏液灌注方式,取得最佳心肌保护效果提供高等级循证医学证据。方法：计算机检索1992-2015年PubMed、Ovid、EMBASE、Highwire、Cochrane图书馆及中国期刊全文数据库（CNKI）与万方数据库等中外文数据库,收集有关比较联合灌注与单纯顺灌心脏停搏液对术后心功能影响的临床随机对照研究。按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.1软件进行Meta分析。结果：纳入文献14篇,患者728例。联合灌注组术后恶性心律失常发生率（4项研究,231病例,OR=2.82,95%CI=1.16～6.86,P=0.02）与需要使用正性肌力药物支持的患者比例（7项研究,450病例,OR=2.02,95%CI=1.11～3.68,P=0.02）均低于顺灌组;低心排出量、围术期心肌梗死及30d内死亡率组间差异无统计学意义。冠脉搭桥手术中,联合灌注组主动脉开放后心脏一次性复跳率优于顺灌组（2项研究,79病例,OR=0.05,95%CI=0.01～0.25,P=0.0002）。结论：联合灌注心脏停搏液较单纯顺灌能够减少体外循环下停跳心脏手术中心脏不良事件的发生率,这一区别在冠脉搭桥手术中更为明显。Objective：To compare cardiac function recovery between antegrade and combined retrograde cardioplegic delivery strategies,and to discovery which strategy is better in different cardiac disease and surgery.Method：Published RCT papers about cardioplegic delivery strategy were searched in Pubmed,OVID,EMBASE,Cochrane library,Highwire,CNKI and Wanfang data since 1992 till now.Cochrane system was used to evaluate the included literature quality,and the RevMan5.1software was used to take Meta analysis.Result：A total of 728 patients from 14 papers was included.There was lower intropic user ratio（7trails,450 patients,OR=2.02,95%CI=1.11-3.68,P=0.02）and severe arrhythmia（4trails,231 patients,OR=2.82,95%CI=1.16-6.86,P=0.02）.There was no difference in low output,peri-operative MI and death in 30 days between groups.In CABG subgroup,the ratio of sinus after declamping（2trails,79 patients,OR=0.05,95%CI=0.01-0.25,P=0.0002）was higher in combination group.Conclusion：Comparing to antegrade delivery,combined delivery can reduce adverse cardiac events in cardiac arrest surgery under cardiopulmonary bypass,especially in coronary artery bypass grafting.

关 键 词：心肌保护 心脏停搏液 顺灌/逆灌 META分析 

分 类 号：R542.2[医药卫生—心血管疾病]