单侧与双侧顺行性脑灌注在主动脉停循环手术中脑保护效果比较的Meta分析  

A meta-analysis of the effects of unilateral versus bilateral antegrade cerebral perfusion on the cerebral protection of patients undergoing circulatory arrest in aortic surgery

作　　者：汪源[1] 周曼玲[1] 黄飞[1] 邹艳[1] 周颖[1] 石平[1] WANG Yuan;ZHOU Manling;HUANG Fei;ZOU Yan;ZHOU Ying;SHI Ping(Department of Cardiovascular Surgery,Tongji Hospital Affiliated to Tongji Medical College ofHuazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,湖北武汉430030

出　　处：《安徽医药》2019年第4期747-751,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的通过比较单侧顺行性脑灌注(UACP)与双侧顺行性脑灌注(BACP)在主动脉停循环手术中脑保护效果,探讨最佳的保护性脑灌注手段。方法通过检索国内外(2005年1月至2016年12月),收集单侧与双侧顺行性脑灌注在主动脉停循环手术脑保护效果的随机对照研究,以文献质量评价量表(NOS量表)评价纳入研究的偏倚风险,对提取的结局指标进行Meta分析。结果纳入研究7篇,含病例827例,其中UACP组404例,BACP组423例;7项研究比较两组30 d病死率,差异无统计学意义(OR=1.01,95%CI:0.64～1.61,P=0.95);6项研究比较了两组暂时性神经系统障碍(temporary neurologic dysfunction,TND),两组间差异有统计学意义(OR=1.65,95%CI:1.11～6.28,P=0.049 99)且BACP要优于UACP;5项研究比较两组永久性神经系统障碍(permanent neurologic dysfunction, PND),差异无统计学意义(OR=0.83,95%CI:0.49～1.42,P=0.50)。结论在主动脉停循环手术中,双侧顺行性脑灌注脑保护效果优于单侧脑灌注。Objective To explore the best means of protective cerebral perfusion by determining the effects of unilateral(UACP)versus bilateral antegrade cerebral perfusion(BACP)during circulatory arrest in aortic surgery.Methods We collected randomized controlled trials of the effects of unilateral versus bilateral antegrade cerebral perfusion on the cerebral protection of patients undergoing circulatory arrest in aortic surgery by means of searching the literature(January 2005-December 2016)home and abroad.Outcomes distilled from these studies were analyzed with Meta-analysis,and the risk of bias of these studies was evaluated by NOS scale.Results Seven studies were included with 827 cases,of which there were 404 patients in UACP group and 423 patients in BACP group.The 7 studies compared 30 day mortality between two groups and found no significant difference(OR=1.01,95%CI:0.64-1.61,P=0.95);6 studies compared temporary neurologic dysfunction(TND)between two groups and found a significant difference(OR=1.65,95%CI:1.11-6.28,P=0.049 99)with BACP group superior to UACP group;5 studies compared permanent neurologic dysfunction(PND)between two groups and found no statistically significant difference(OR=0.83,95%CI:0.49-1.42,P=0.50).Conclusion During circulatory arrest in aortic surgery,BACP achieves better cerebral protection than UACP.

关 键 词：停循环 深低温诱导 导管 留置 主动脉 胸 大脑动脉环 侧支循环 顺行性脑灌注 脑保护 META分析 

分 类 号：R654.1[医药卫生—外科学]