中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
8期
759-763
,共5页
马海平%努尔比艳·克尤木%陈林%郑宏
馬海平%努爾比豔·剋尤木%陳林%鄭宏
마해평%노이비염·극우목%진림%정굉
心脏外科手术%手术期间%抗纤维蛋白溶解酶
心髒外科手術%手術期間%抗纖維蛋白溶解酶
심장외과수술%수술기간%항섬유단백용해매
Cardiac surgical procedures%Intraoperative period%Antifibrinolytic agents
目的 评价实施抗血小板治疗的冠状动脉旁路移植术(CABG)患者围手术期抗纤溶治疗的效果.方法 采用Cochrane系统评价方法,检索PubMed、EMbase、Highwire、CENTREN及其下属各临床注册试验数据中心数据库、中国生物医学文献数据库、中国期刊全文数据库.收集2000至2010年,实施抗血小板治疗(包括抑肽酶和氨甲环酸)的CABG患者围手术期抗纤溶治疗有效性方面的临床随机对照试验.按Cochrane系统评价方法,由2名评价者独立评价所纳入研究的文献质量,提取有效数据后,采用RevMan 5.0软件进行荟萃分析.结果 纳入11项研究,共计725例患者.荟萃分析显示:与空白对照治疗比较,实施抗血小板治疗CABG患者围手术期抗纤溶治疗的术后24h出血量较少(MD=-306.52 ml,95%CI:-351.52～-261.52,P＜0.01),需要输血的人数较少(OR=0.37,95%CI:0.26～0.51,P＜0.01),平均输血量较少(MD=-0.59 U,95%CI:-0.69～-0.50,P＜0.01),二次手术人数较少(OR=0.27,95%CI:0.09～0.78,P=0.02),血栓事件的发生率较低(OR=0.49,95%CI:0.25～0.97,P=0.04).结论 实施抗血小板治疗的CABG患者围手术期合理抗纤溶治疗可以有效减少术后24 h出血量、输血量和二次手术,并且不增加血栓事件的发生率.
目的 評價實施抗血小闆治療的冠狀動脈徬路移植術(CABG)患者圍手術期抗纖溶治療的效果.方法 採用Cochrane繫統評價方法,檢索PubMed、EMbase、Highwire、CENTREN及其下屬各臨床註冊試驗數據中心數據庫、中國生物醫學文獻數據庫、中國期刊全文數據庫.收集2000至2010年,實施抗血小闆治療(包括抑肽酶和氨甲環痠)的CABG患者圍手術期抗纖溶治療有效性方麵的臨床隨機對照試驗.按Cochrane繫統評價方法,由2名評價者獨立評價所納入研究的文獻質量,提取有效數據後,採用RevMan 5.0軟件進行薈萃分析.結果 納入11項研究,共計725例患者.薈萃分析顯示:與空白對照治療比較,實施抗血小闆治療CABG患者圍手術期抗纖溶治療的術後24h齣血量較少(MD=-306.52 ml,95%CI:-351.52～-261.52,P＜0.01),需要輸血的人數較少(OR=0.37,95%CI:0.26～0.51,P＜0.01),平均輸血量較少(MD=-0.59 U,95%CI:-0.69～-0.50,P＜0.01),二次手術人數較少(OR=0.27,95%CI:0.09～0.78,P=0.02),血栓事件的髮生率較低(OR=0.49,95%CI:0.25～0.97,P=0.04).結論 實施抗血小闆治療的CABG患者圍手術期閤理抗纖溶治療可以有效減少術後24 h齣血量、輸血量和二次手術,併且不增加血栓事件的髮生率.
목적 평개실시항혈소판치료적관상동맥방로이식술(CABG)환자위수술기항섬용치료적효과.방법 채용Cochrane계통평개방법,검색PubMed、EMbase、Highwire、CENTREN급기하속각림상주책시험수거중심수거고、중국생물의학문헌수거고、중국기간전문수거고.수집2000지2010년,실시항혈소판치료(포괄억태매화안갑배산)적CABG환자위수술기항섬용치료유효성방면적림상수궤대조시험.안Cochrane계통평개방법,유2명평개자독립평개소납입연구적문헌질량,제취유효수거후,채용RevMan 5.0연건진행회췌분석.결과 납입11항연구,공계725례환자.회췌분석현시:여공백대조치료비교,실시항혈소판치료CABG환자위수술기항섬용치료적술후24h출혈량교소(MD=-306.52 ml,95%CI:-351.52～-261.52,P＜0.01),수요수혈적인수교소(OR=0.37,95%CI:0.26～0.51,P＜0.01),평균수혈량교소(MD=-0.59 U,95%CI:-0.69～-0.50,P＜0.01),이차수술인수교소(OR=0.27,95%CI:0.09～0.78,P=0.02),혈전사건적발생솔교저(OR=0.49,95%CI:0.25～0.97,P=0.04).결론 실시항혈소판치료적CABG환자위수술기합리항섬용치료가이유효감소술후24 h출혈량、수혈량화이차수술,병차불증가혈전사건적발생솔.
Objective To evaluate the efficacy of antifibrinolytic agents in coronary artery bypass grafting (CABG) patients receiving antiplatelet. Methods We searched PubMed, EMbase, Highwire,CENTREN and its affiliated clinical trial registration data center, CBMdisc and CNKI databases from 2000 to 2010. Randomized controlled trials investigating the efficacy of anti-fibrinolytic agents (aprotinin and tranexamic acid) in CABG patients were identified. Study selection and meta-analysis were conducted according to the Cochrane Handbook for systematic reviews. Date were extracted from these trials by 2 reviewers independently and analyzed by RevMan 5.0 software. Result Eleven RCT trials ( n = 725 ) were included and data confirmed the efficacy of antifibrinolytic therapy in terms of reducing bleeding within 24 hours after operation(MD = - 306. 5 ml, 95% CI: - 351.52 to - 261.52, P ＜ 0. 01 ), number of patients who need blood transfusion ( OR = 0. 37, 95% CI: 0. 26 to 0. 51, P ＜ 0. 01 ), amount of blood transfusion ( MD = - 0. 59 U,95 % CI: - 0. 69 to - 0. 50, P ＜ 0. 01 ), surgical re-exploration ( OR = 0. 27,95 % CI: 0. 09 to 0. 78 ,P =0. 02), and thrombotic events( OR =0. 49,95% CI:0. 25 to 0. 97 ,P =0. 04) in CABG patients receiving antiplatelet, while compared with blank treatment. Conclusion This analysis showed that antifibrinolytic agents are effective for reducing bleeding within 24 hours after operation, amount of blood transfusion, surgical re-exploration and do not increase the incidence of thrombotic events in CABG patients receiving antiplatelet before operation.
