CAJ | 학술논문

目的对比顺行性脑灌注下置换主动脉弓部手术中不同温度停循环技术对手术结果的影响，为术中选择的合适温度提供依据。方法应用Pubmed、Embase、Cochrane Library数据库检索不同温度停循环联合顺行性脑灌注辅助下实施主动脉弓置换术的文章，纳入文章应报道术后结果。由两位调查者分别阅读文献并获取资料用于Meta分析。研究采用STATA 11.2进行荟萃分析，Cochrane Q检验和I2检验进行研究组间异质性检验。结果通过检索，共纳入8篇文献，每两组不同温度间结果对比均具有3篇及3篇以上文献结果用于分析。分析结果：深低温组、中度低温组术前急诊患者比例、主动脉夹层患者比例、全主动脉弓置换术比例两组没有差别（P＞0.05），浅低温组相对于深低温组、中度低温组急诊患者、主动脉夹层患者、全主动脉弓置换术患者所占比例较低（ P＜0.05）。数据分析：三组间术后早期病死率无明显差异[ OR1＝0.74，95％CI（0.35，1.55），OR2＝0.31，95％CI（0.06，1.50），OR3＝0.83，95％CI（0.46，1.50）]，术后短暂性神经功能障碍发生率三组间无明显差异[ OR1＝0.82，95％ CI （0.43，1.56）， OR2＝0.68，95％ CI （0.25，1.80），OR3＝0.68，95％ CI（0.38，1.23）]，术后持续性神经功能障碍发生率三组间无明显差异[OR1＝0.75，95％CI（0.16，3.45），OR2＝0.20，95％ CI（0.04，1.14），OR3＝0.78，95％CI（0.29，2.14）]。结论在顺行性脑灌注辅助下行主动脉弓部手术过程中深低温及中度低温停循环均可提供良好的脑保护作用，浅低温在复杂性主动脉弓部手术中的应用仍有待于进一步评价。
목적대비순행성뇌관주하치환주동맥궁부수술중불동온도정순배기술대수술결과적영향，위술중선택적합괄온도제공의거。방법응용Pubmed、Embase、Cochrane Library수거고검색불동온도정순배연합순행성뇌관주보조하실시주동맥궁치환술적문장，납입문장응보도술후결과。유량위조사자분별열독문헌병획취자료용우Meta분석。연구채용STATA 11.2진행회췌분석，Cochrane Q검험화I2검험진행연구조간이질성검험。결과통과검색，공납입8편문헌，매량조불동온도간결과대비균구유3편급3편이상문헌결과용우분석。분석결과：심저온조、중도저온조술전급진환자비례、주동맥협층환자비례、전주동맥궁치환술비례량조몰유차별（P＞0.05），천저온조상대우심저온조、중도저온조급진환자、주동맥협층환자、전주동맥궁치환술환자소점비례교저（ P＜0.05）。수거분석：삼조간술후조기병사솔무명현차이[ OR1＝0.74，95％CI（0.35，1.55），OR2＝0.31，95％CI（0.06，1.50），OR3＝0.83，95％CI（0.46，1.50）]，술후단잠성신경공능장애발생솔삼조간무명현차이[ OR1＝0.82，95％ CI （0.43，1.56）， OR2＝0.68，95％ CI （0.25，1.80），OR3＝0.68，95％ CI（0.38，1.23）]，술후지속성신경공능장애발생솔삼조간무명현차이[OR1＝0.75，95％CI（0.16，3.45），OR2＝0.20，95％ CI（0.04，1.14），OR3＝0.78，95％CI（0.29，2.14）]。결론재순행성뇌관주보조하행주동맥궁부수술과정중심저온급중도저온정순배균가제공량호적뇌보호작용，천저온재복잡성주동맥궁부수술중적응용잉유대우진일보평개。
Objective To compare the postoperation outcome among different temperature for hypothermic circulation arrest with antegrade cerebral perfusion in aortic arch surgery ,to determine which temperature provides best brain protection .Methods Pubmed ,Embase and Cochrane Library were searched for studies reporting on the postoperation outcome in aortic arch replacement with different hypothermic circulation arrest with antegrade cerebral perfusion.Two principle investigators respectively extracted the information for Meta-analysis.Meta-analyses were conducted using STATA version 11.2 .Analysis of heterogeneity was performed with the Cochrane Q statistic and the I2statistics.Results 8 studies were selected to analysis ,no less than 3 studies could be used to analysis the result between every two different groups .Pooled analysis showed that Mild hypothermic circulation arrest ( Mild HCA) group patients had lower percentage of , emergency , aortic dissection and aortic arch replacement than the other two groups.However, there were no significant differences for mortality among Mild , Moderate and Deep hypothermic circulation arrest groups [OR1 =0.74,95% CI(0.35,1.55),OR2 =0.31,95% CI(0.06,1.50), OR3=0.83,95%CI(0.43,1.50)],similar rates of temporary neurologic dysfunction (TND)[OR1=0.82,95%CI(0.43,1.56),OR2=0.68,95% CI(0.25,1.80),OR3=0.68,95% CI(0.38,1.23)],also similar rates of permanent neurologic dysfunction(PND)[OR1=0.75,95%CI(0.16,3.45),OR2=0.20,95%CI(0.04,1.14), OR3=0.78,95% CI(0.29,2.14)].Conclusions Deep hypothermic circulation arrest (DHCA)and Moderate hypothermic circulation arrest ( Moderate HCA ) with antegrade cerebral perfusion offer effective cerebral and neurological protection,Mild hypothermic circulation arrest ( Mild HCA) may not suitable to use in complex aortic arch surgery .