主动脉弓部手术中顺行和逆行脑灌注脑保护疗效比较meta分析  

Meta-analysis of the effects of anterograde and retrograde cerebral perfusion in aortic arch surgery

作　　者：张祖磊 杨威[2] 龚艺[2] 尤苗苗 许伟长 芦潮 董啸[2] Zhang Zulei;Yang Wei;Gong Yi;You Miaomiao;Xu Weichang;Lu Chao;Dong Xiao(Department of Medicine,Nanchang University,Nanchang 330006,China;Department of Cardiovascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学医学部研究生院,330006 [2]南昌大学第二附属医院心脏大血管外科,330006

出　　处：《中华胸心血管外科杂志》2019年第9期546-550,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨比较主动脉弓部手术中使用顺行脑灌注(ACP)和逆行脑灌注(RCP)两种技术的脑保护疗效和安全性.方法检索Cochrane图书馆、PubMed、EMBASE、万方数据库和中国生物医学数据库,搜索近5年内(2013年1月1日至2018年12月16日)包含主动脉弓部手术的全部相关文献.以术后早期死亡、短暂性神经功能障碍(TND)、卒中及短暂性脑缺血发作(TIA)为结局,进行队列研究.每项研究均使用ACP和RCP中终点数据产生相对危险度(RR)和95%置信区间(CI).使用漏斗图测试发表偏倚.结果共纳入12项研究,包含6692例患者,其中3902例接受低温停循环+ACP治疗(ACP组),2790例接受低温停循环+RCP治疗(RCP组).汇总分析显示,两组在术后早期死亡(RR=0.83,95%CI=0.51~1.35,P=0.46),卒中(RR=1.09,95%CI=0.91~1.31,P=0.33),短暂性神经功能障碍(RR=0.81,95%CI=0.17~3.91,P=0.80)和短暂性脑缺血发作(RR=1.00,95%CI=0.74~1.34,P=1.00)方面,差异均无统计学意义(P>0.05).结论结合低温停循环技术,主动脉弓部手术中使用ACP和RCP在术后病死率、神经功能障碍方面的差异均无统计学意义,可根据主动脉弓部手术的实际情况选择.Objective To explore the differences in brain protection between anterograde cerebral perfusion(ACP) and retrograde cerebral perfusion(RCP) in aortic arch surgery. Methods Aortic arch circulatory surgery, ACP and RCP techniques were searched at the Cochrane Library, PubMed, EMBASE, Wanfang Database and the Chinese Biomedical Database from January 2013 to December 2018. Cohort studies were then performed with early postoperative death, transient neurological dysfunction(TND), stroke, and transient ischemic attack(TIA). For each study, data on endpoints in the ACP and RCP groups were used to generate risk ratios(RR) and 95% confidence intervals(CI). The funnel chart was used to test publication bias. Results A total of 6 692 patients were enrolled in 12 studies, of which 3 902 patients received low-temperature circulatory arrest plus ACP, and 2 790 patients received low-temperature circulatory arrest plus RCP. Summary analysis showed that the early postoperative death(RR=0.83, 95%CI=0.51-1.35, P=0.46), stroke(RR=1.09, 95%CI=0.91-1.31, P=0.33), transient neurological dysfunction(RR=0.81, 95%CI=0.17-3.91, P=0.80) and transient ischemic attack(RR=1.00, 95%CI=0.74-1.34, P=1.00) in both groups were no significant differences(all P>0.05). Conclusion There are no significant differences in postoperative mortality and neurological dysfunction between antegrade cerebral perfusion and retrograde cerebral perfusion in the aortic arch surgery. Combined with hypothermic circulatory arrest, it can be selected according to the actual situation of aortic arch surgery.

关 键 词：主动脉弓部手术 顺行脑灌注 逆行脑灌注 脑保护 

分 类 号：R654.2[医药卫生—外科学]