颈动脉血管重建与冠状动脉旁路移植术同期进行的可行性和有效性Meta分析  

Safety and Efficacy of Simultaneous Carotid Vascular Reconstruction Combined With Coronary Bypass Grafting: A Meta-analysis

作　　者：王园园[1] 耿雪[2] 呼海娟[2] 柳磊[1] 李召彬[1] 张朝霞[1] WANG Yuanyuan;GENG Xue;HU Haijuan;LIU Lei;LI Zhaobin;ZHANG Zhaoxia(Cardiac Surgery Department,The Third Hospital of Hebei Medical University,Shijiazhuang (050001),Hebei,China)

机构地区：[1]河北医科大学第三医院心外科,河北省石家庄市050001 [2]河北医科大学第二医院心内一科河北省心血管病研究所

出　　处：《中国循环杂志》2019年第3期281-288,共8页Chinese Circulation Journal

基　　金：河北省医学科学研究重点课题(20180467)

摘　　要：目的:评价颈动脉血管重建与冠状动脉旁路移植术(CABG)同期进行的可行性和有效性。方法:计算机检索从1990年1月到2018年4月的相关文献资料,包括检索MEDLINE、EMBASE数据库、中国知网、Corchrane图书馆及二次资源。颈动脉血管重建为颈动脉内膜剥脱术(CEA)或颈动脉支架置入术(CAS)。Meta分析CABG+CEA/CAS同期手术与分阶段手术或单纯行CABG患者的早期(术后30 d)脑卒中、死亡和心肌梗死发生率。结果:共纳入25篇文献,总计117 669例患者。Meta分析结果显示:对比CABG+CEA/CAS分阶段手术,CABG+CEA/CAS同期手术后脑卒中发生率显著增加(OR=1.52,95%CI:1.30～1.79, I^2=28%,P<0.00001),死亡率差异无统计学意义(OR=1.13,95%CI:0.73～1.76, I^2=0%,P=0.59),心肌梗死发生率降低(OR=0.12,95%CI:0.06～0.26,I^2=32%,P<0.00001)。对比单纯行CABG,CABG+CEA/CAS同期手术在脑卒中发生率(OR=1.51,95%CI:0.77～2.96,I^2=0%,P=0.23)和心肌梗死发生率(OR=0.73,95%CI:0.40～1.33, I^2=9%,P=0.3)差异无统计学意义,但死亡率显著增加(OR=3.23,95%CI:1.44～7.24, I^2=0%,P=0.005)。结论:颈动脉血管重建与CABG同期进行可行、有效,但需要严格筛查手术病例,以避免围术期脑卒中的发生。Objections: To evaluate the feasibility and effectiveness of simultaneous carotid vascular reconstruction combined with coronary bypass grafting(CABG).Methods: Relevant documents were searched from January 1990 to April 2018 through retrieval of MEDLINE, EMBASE databases, China Information Network, Cochrane library and secondary resources. The reconstruction of the carotid artery is defined as either carotid endarterectomy(CEA) or carotid artery stenting(CAS). Incidence of stroke, death, and myocardial infarction at 30 days after surgery was compared among patients receiving CABG + CEA/CAS during the same period, staged CABG + CEA/CAS surgery or CABG only.Results: Twenty-five studies were identified with a total of 117 669 patients. The analysis revealed that incidence of postoperative stroke(OR=1.52, 95%CI: 1.30-1.79], I^2=28%, P<0.00001)was significantly increased, while the incidence of early MI(OR=0.12, 95%CI: 0.06-0.26], I^2=32%, P<0.00001)was significantly decreased in the combined group compared with the staged group, mortality was similar between the combined and staged groups(OR=1.13, 95%CI: 0.73-1.76, I^2=0%, P=0.59). There is no difference in the early stroke rate(OR=1.51, 95%CI: 0.77-2.96, I^2=0%, P=0.23) and MI rate(OR=0.73, 95%CI:0.40-1.33, I^2=9%, P=0.3) between combined group and CABG only group, while early mortality rate was significantly higher in the combined group than in CABG only group(OR=3.23, 95%CI: 1.44-7.24, I^2=0%, P=0.005).Conclusions: In conclusion, simultaneous CABG + CEA/CAS surgery is a safe and effective surgical approach, but strict surgical screening and patient selection is required to avoid the occurrence of perioperative stroke.

关 键 词：冠状动脉旁路移植术 颈内动脉内膜剥脱术 颈动脉支架置入术 Meta分析 

分 类 号：R541.6[医药卫生—心血管疾病]