远端缺血预适应联合远端缺血后适应对复杂心脏外科手术术后肺功能影响的Meta分析  

Effects of combined remote ischemic preconditioning and postconditioning on pulmonary function after complex cardiac surgery: a Meta-analysis

作　　者：赵世杰[1] 齐国先[1] 田文[1] 史立业[1] 陈玲[1] 

机构地区：[1]中国医科大学附属第一医院老年心血管内科,辽宁沈阳110001

出　　处：《现代医学》2017年第3期362-367,共6页Modern Medical Journal

摘　　要：目的:探讨联合应用远端缺血预适应(remote ischemic preconditioning,RIPC)与远端缺血后适应(remote ischemic postconditioning,RIPost C)对复杂心脏外科手术术后肺功能的影响。方法:计算机检索Pub Med、Embase、Cochrane Library以及Web of Science等数据库,查找对比联合应用RIPC及RIPost C治疗方案与常规治疗方案对复杂心脏外科手术术后肺功能影响的随机对照实验(RCT),检索时限为建库至2016年7月。由两位研究者根据纳入标准独立筛选文献、提取资料并进行质量评价后,应用STATA12.0统计软件进行Meta分析。结果:最终纳入3项RCT研究,共189例患者,其中对照组94例,实验组95例。Meta分析结果显示:RIPC+RIPost C组在复杂心脏外科手术术后24 h氧合指数(oxygenation index,OI)、重症监护室(intensive care unit,ICU)治疗时间相比对照组显示了改善趋势,但结果未达到统计学差异[OI:I^2=65.5%,P=0.055;SMD=0.319,95%CI(-0.175,0.814),P=0.206;ICU治疗时间:I^2=0.0%,P=0.445;WMD=-0.429,95%CI(-0.954,0.096),P=0.109]。结论:联合应用RIPC及RIPost C对复杂心脏外科手术术后24 h OI、ICU住院时间显示了改善趋势,但结果未达到统计学差异。考虑研究存在的限制性,尚需进一步大规模的RCT研究。Objective： To investigate the effect of combined remote ischemic preconditioning（ RIPC） and postconditioning（ RIPost C） on pulmonary function after complex cardiac surgery. Methods： All full-text published studies compared the effects of combined RIPC and RIPost C on pulmonary function with control group after complex cardiac surgery were identified. Databases including Pubmed,Embase,Cochrane Library and Web of Science were searched through July 2016 without time and language limitation. The endpoints were defined as oxygenation index（ OI） 24 h after cardiac surgery and intensive care unit（ ICU） stay length. Results： Three RCTs,involving a total of 189 patients,were included into this Meta-analysis. The results showed there was a trend indicating improvement in the RIPC ＋ RIPost C group both on OI 24 h after cardiac surgery[I-2= 65. 5%,P = 0. 055; SMD = 0. 319,95 %CI（-0. 175,0. 814）,P = 0. 206] and ICU stay length[I-2= 0. 0%,P = 0. 445; WMD =-0. 429,95 % CI（-0. 954,0. 096）,P = 0. 109],but the results did not reach statistical significance. Conclusion： Combined RIPC and RIPost C was associated with a trend indicating improvement both on OI 24 h after cardiac surgery and ICU stay length,though the results don＇t reach statistical significance. Due to the limitations of the study,additional high quality RCTs are needed.

关 键 词：远端缺血预适应 远端缺血后适应 心脏外科手术 肺功能 

分 类 号：R654.2[医药卫生—外科学]