冠状动脉旁路移植术后低氧血症危险因素的系统评价与Meta分析  

Risk factors for hypoxemia after coronary artery bypass grafting: A systematic review and meta-analysis

作　　者：向玉萍 曾玲[1] 罗天会[1] 黄凯琴 XIANG Yuping;ZENG Ling;LUO Tianhui;HUANG Kaiqin(Department of Intensive Care Unit/West China School of Nursing,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院重症医学科胸外ICU/华西护理学院,成都610041

出　　处：《中国胸心血管外科临床杂志》2020年第8期926-932,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的系统评价冠状动脉旁路移植术(CABG)后低氧血症的危险因素。方法计算机检索PubMed、EMbase、CENTRAL、Web of Science、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方数据库(Wanfang data)。检索时限为建库至2020年3月,收集国内外有关CABG后低氧血症的病例对照研究和前瞻性队列研究,由两名研究者独立筛选文献、提取资料后,采用纽卡斯尔-渥太华量表(NOS)评价研究质量,并采用RevMan 5.3软件进行Meta分析。结果共纳入15项研究(3项队列研究,12项病例对照研究),包含4277例患者,其中低氧血症患者1273例。共纳入29个独立危险因素,Meta分析结果显示,年龄[OR=1.55,95%CI(1.22,1.96),P=0.0003]、吸烟[OR=3.22,95%CI(2.48,4.17),P<0.00001]、术前慢性肺疾病[OR=4.75,95%CI(3.28,6.86),P<0.00001]、糖尿病[OR=2.49,95%CI(1.86,3.33),P<0.00001]、左室射血分数[OR=3.15,95%CI(2.19,4.52),P<0.00001]、冠状动脉病变支数[OR=2.20,95%CI(1.63,2.97),P<0.0001]是CABG后低氧血症的独立危险因素。体重指数[OR=1.31,95%CI(0.97,1.77),P=0.08]、体外循环时间[OR=3.40,95%CI(0.72,15.94),P=0.12]与CABG后低氧血症不相关。结论现有证据表明,年龄、术前慢性肺疾病、吸烟、糖尿病、左室射血分数、冠状动脉病变支数是CABG后低氧血症的危险因素,可用于识别高危患者,为医务人员制定围术期预防性管理策略提供指导依据,从而降低低氧血症发生率,改善患者临床结局。鉴于研究数量和质量有限,该研究尚需进一步的高质量研究加以证实。Objective To systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting(CABG).Methods Eight electronic databases including PubMed,EMbase,CENTRAL,Web of Science,CNKI,CBM,VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020.Two authors independently assessed the quality using the NewcastleOttawa Scale(NOS),and a meta-analysis was performed by RevMan 5.3 software.Results A total of 15 studies involving 4277 patients were included in this study and among them 1273 patients suffered hypoxemia.Meta-analysis showed that age(OR=1.55,95%CI 1.22 to 1.96,P=0.0003),smoking(OR=3.22,95%CI 2.48 to 4.17,P<0.00001),preoperative chronic pulmonary diseases(OR=4.75,95%CI 3.28 to 6.86,P<0.00001),diabetes(OR=2.49,95%CI 1.86 to 3.33,P<0.00001),left ventricular ejection fraction(OR=3.15,95%CI 2.19 to 4.52,P<0.00001),number of coronary artery lesions(OR=2.20,95%CI 1.63 to 2.97,P<0.0001)were independent risk factors for hypoxemia after CABG;body mass index(OR=1.31,95%CI 0.97 to 1.77,P=0.08)and cardiopulmonary bypass time(OR=3.40,95%CI 0.72 to 15.94,P=0.12)were not associated with hypoxemia.Conclusion Current evidence shows that age,preoperative chronic pulmonary diseases,smoking,diabetes,left ventricular ejection fraction,number of coronary artery are risk factors for hypoxemia after CABG,which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia.The results should be validated by large-scale standard studies in the future.

关 键 词：冠状动脉旁路移植术 低氧血症 危险因素 系统评价/META分析 

分 类 号：R654.2[医药卫生—外科学]