CAJ | 학술논문

目的采用meta分析评价不同剂量糖皮质激素预防患者冠状动脉旁路移植术后并发症的效果.方法检索PubMed、EMbase、Highwire、CENTREN及其下属各临床注册试验数据中心、中国生物医学文献数据库和中国期刊全文数据库,检索时间限定2000年至2010年.收集冠状动脉旁路移植术患者给予不同剂量糖皮质激素预防术后并发症的随机对照研究.采用Cochrane协作网系统评价文献质量,并分析有关资料,主要包括术后房颤的发生情况、术后因高血糖需胰岛素治疗的情况、术后感染发生情况、术后死亡情况(住院期间或出院30 d内)和机械通气时间.采用RevMan 5.1软件进行meta分析.结果纳入21项研究,共1737例患者.冠状动脉旁路移植术患者给予不同剂量糖皮质激素可降低术后房颤发生的风险,不增加各种原因感染及死亡的风险；中、大剂量增加因高血糖需要胰岛素治疗的风险；大剂量糖皮质激素患者机械通气时间延长.结论冠状动脉旁路移植术患者给予不同剂量糖皮质激素可降低术后房颤的发生风险,且不增加感染和死亡的风险；中、大剂量可增加因高血糖需胰岛素治疗的风险；大剂量可增加机械通气时间延长的风险.
목적 채용meta분석평개불동제량당피질격소예방환자관상동맥방로이식술후병발증적효과.방법 검색PubMed、EMbase、Highwire、CENTREN급기하속각림상주책시험수거중심、중국생물의학문헌수거고화중국기간전문수거고,검색시간한정2000년지2010년.수집관상동맥방로이식술환자급여불동제량당피질격소예방술후병발증적수궤대조연구.채용Cochrane협작망계통평개문헌질량,병분석유관자료,주요포괄술후방전적발생정황、술후인고혈당수이도소치료적정황、술후감염발생정황、술후사망정황(주원기간혹출원30 d내)화궤계통기시간.채용RevMan 5.1연건진행meta분석.결과 납입21항연구,공1737례환자.관상동맥방로이식술환자급여불동제량당피질격소가강저술후방전발생적풍험,불증가각충원인감염급사망적풍험；중、대제량증가인고혈당수요이도소치료적풍험；대제량당피질격소환자궤계통기시간연장.결론 관상동맥방로이식술환자급여불동제량당피질격소가강저술후방전적발생풍험,차불증가감염화사망적풍험；중、대제량가증가인고혈당수이도소치료적풍험；대제량가증가궤계통기시간연장적풍험.
Objective To evaluate the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing coronary artery bypass grafting (CABG).Methods We searched PubMed,EMBASE,Highwire,CENTREN and its affiliated clinical trial registration data center,Chinese Biomedical Database,and CNKI from 2000 to 2010 for randomized controlled trials involving the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing CABG.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included development of fibrillation,requirement for insulin treatment because of hyperglycosemia,infection,and death (during stay in hospital or within 30 days after discharge from hospital) after operation and mechanical ventilation time.Meta-analysis was conducted using the RevMan 5.1 software.Results Twenty-one randomized controlled trials involving 1737 patients were included in our meta-analysis.Different doses of glucocorticoid decreased the risk of fibrillation,and did not increase the risk of various causes-induced infection and death.Moderate and large doses of glucocorticoid increased the risk of requirement for insulin treatment because of hyperglucosemia.Large dose of glucocorticoid resulted in prolongation of ventilation time.Conclusion Different doses of glucocorticoid can decrease the development of postoperative fibrillation without increasing the risk of infection and death,moderate and large doses of glucocorticoid increase the risk of requirement for insulin treatment because of hyperglucosemia and large dose of glucocorticoid increases the risk of prolonged ventilation time in patients undergoing CABG.