主动脉弓部手术中单用深低温停循环与结合选择性顺行脑灌注临床疗效比较的Meta分析  

Clinical Efficacy of Deep Hypothermic Circulatory Arrest and Combined Deep Hypothermic Circulatory Arrest With Selective Antegrade Cerebral Perfusion in Aortic Arch Surgery:a Meta-analysis

作　　者：张祖磊 杨威[2] 龚艺[2] 芦潮 余凡 周明富 董啸[2] ZHANG Zulei;YANG Wei;GONG Yi;LU Chao;YU Fan;ZHOU Mingfu;DONG Xiao(Graduate School of Medicine,Nanchang University,Nanchang(330006),Jiangxi,China)

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

出　　处：《中国循环杂志》2020年第7期685-691,共7页Chinese Circulation Journal

基　　金：国家自然科学基金地区科学基金(81660073);江西省青年科学基金(20161BAB215236)。

摘　　要：目的:探讨在主动脉弓部手术中单独使用深低温停循环(DHCA)与DHCA结合选择性顺行脑灌注(ASCP)两种技术的临床疗效差异。方法:检索Cochrane图书馆、PubMed、EMBASE、万方和中国知网数据库,搜索2009年1月至2019年9月包含主动脉弓部手术的全部相关文献并进行筛选,以术后早期死亡、短暂性神经功能障碍(TND)、脑卒中及永久性神经功能障碍(PND)为结局进行Meta分析。每项研究均使用DHCA和DHCA+ASCP中终点数据产生RR和95%CI进行比较,使用Egger检验测试发表偏倚。结果:共纳入14项研究,包含5008例患者,其中3278例接受DHCA+ASCP治疗(DHCA+ASCP组),1730例接受DHCA治疗(DHCA组)。结果显示,DHCA+ASCP组在术后早期死亡(RR=0.74,95%CI:0.62~0.88,P=0.001)和PND(RR=0.79,95%CI:0.63~0.99,P=0.041)方面均优于DHCA组;两组在脑卒中(RR=0.72,95%CI:0.47~1.10,P=0.130)和TND(RR=0.99,95%CI:0.76~1.29,P=0.930)方面差异无统计学意义。结论:在主动脉弓部手术中,使用DHCA+ASCP可以降低术后早期死亡风险,减少永久性神经功能障碍的发生风险。Objectives:To investigate the clinical efficacy of two techniques:deep hypothermic circulatory arrest(DHCA)alone or DHCA plus selective antegrade cerebral perfusion(DHCA+ASCP)in aortic arch surgery.Methods:The Cochrane Library,PubMed,EMBASE,Wanfang and China Knowledge Network databases were searched for all relevant literature on aortic arch surgery published in the past 10 years.Early postoperative death,transient neurological dysfunction(TND),stroke and permanent neurological dysfunction(PND)were used as cohort study outcomes.The endpoint data derived from DHCA and DHCA+ASCP groups were used to generate relative risk(RR)and 95%confidence interval(CI)for comparison,the Egger test was used to evaluate publication bias.Results:A total of 14 studies were included,including 5008 patients,3278 of whom underwent DHCA+ASCP(DHCA+ASCP group),and 1730 received DHCA therapy(DHCA group)intervention.Results showed that early postoperative mortality(RR=0.74,95%CI:0.62-0.88,P=0.001)and PND(RR=0.79,95%CI:0.63-0.99,P=0.041)were both significantly lower in DHCA+ASCP group than in DHCA group,and there were no significant differences in stroke(RR=0.72,95%CI:0.47-1.10,P=0.130)and TND(RR=0.99,95%CI:0.76-1.29,P=0.930)between the two groups.Conclusions:Use of DHCA+ASCP strategy can reduce the risk of early postoperative death and PND in patients undergoing the aortic arch surgery.

关 键 词：主动脉弓部手术 深低温停循环 顺行脑灌注 脑保护 

分 类 号：R541[医药卫生—心血管疾病]