中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
6期
657-660
,共4页
周程辉%姚允泰%李华同%王伟鹏%李立环
週程輝%姚允泰%李華同%王偉鵬%李立環
주정휘%요윤태%리화동%왕위붕%리립배
性别因素%缺血预处理%成年人%外科手术%心脏%心肌再灌注损伤%Meta分析
性彆因素%缺血預處理%成年人%外科手術%心髒%心肌再灌註損傷%Meta分析
성별인소%결혈예처리%성년인%외과수술%심장%심기재관주손상%Meta분석
Sex factors%Ischemic preconditioning%Adult%Surgical procedures,operative%Heart%Myocardial reperfusion injury%Meta-analysis
目的 采用meta分析评价性别因素和处理策略对远隔缺血预处理减轻心脏手术患者心肌损伤的影响.方法 以相应关键词系统检索PubMed、EMbase、Cochrane Library数据库(检索时间限定为1990年2月至2012年2月)纳入以英文公开发表有关远隔缺血预处理在成年患者心脏手术中产生心肌保护作用的随机对照试验(RCT).分析术后心肌损伤标志物水平,计算标准化均差(SMD).采用发表偏倚和敏感性分析判断结果的可信度.采用Stata 12.0软件进行meta分析.结果 纳入13篇RCT,共985例患者.与对照组比较,远隔缺血预处理明显降低患者术后血清心肌损伤标志物水平(SMD=-0.539；95％CI:-0.926～-0.152；P＜0.05),具有明显异质性(I2=88.7％；P＜0.01).此结果不存在明显的发表偏倚(P=0.083,Begg检验；P=0.077,Egger检验),且敏感性分析显示每个独立的研究对总效应尺度的幅度和方向无明显影响(P＞0.05),结果可信度较高.meta分析结果显示男性(％,回归系数=0.02;95％CI:-0.002 ～ 0.042；P＜0.1；校正R2=19.61％)和总缺血时间(min,回归系数=-0.08;95％CI:-0.154 ～0.002;P＜ 0.1;校正R2=19.47％)是影响远隔缺血预处理减轻心脏手术患者心肌损伤的因素.结论 性别因素可影响远隔缺血预处理减轻患者心脏手术后心肌损伤的效果,减轻女性患者心肌损伤的效果优于男性,适当增加单次缺血时间或总次数可获得更佳的效果.
目的 採用meta分析評價性彆因素和處理策略對遠隔缺血預處理減輕心髒手術患者心肌損傷的影響.方法 以相應關鍵詞繫統檢索PubMed、EMbase、Cochrane Library數據庫(檢索時間限定為1990年2月至2012年2月)納入以英文公開髮錶有關遠隔缺血預處理在成年患者心髒手術中產生心肌保護作用的隨機對照試驗(RCT).分析術後心肌損傷標誌物水平,計算標準化均差(SMD).採用髮錶偏倚和敏感性分析判斷結果的可信度.採用Stata 12.0軟件進行meta分析.結果 納入13篇RCT,共985例患者.與對照組比較,遠隔缺血預處理明顯降低患者術後血清心肌損傷標誌物水平(SMD=-0.539；95％CI:-0.926～-0.152；P＜0.05),具有明顯異質性(I2=88.7％；P＜0.01).此結果不存在明顯的髮錶偏倚(P=0.083,Begg檢驗；P=0.077,Egger檢驗),且敏感性分析顯示每箇獨立的研究對總效應呎度的幅度和方嚮無明顯影響(P＞0.05),結果可信度較高.meta分析結果顯示男性(％,迴歸繫數=0.02;95％CI:-0.002 ～ 0.042；P＜0.1；校正R2=19.61％)和總缺血時間(min,迴歸繫數=-0.08;95％CI:-0.154 ～0.002;P＜ 0.1;校正R2=19.47％)是影響遠隔缺血預處理減輕心髒手術患者心肌損傷的因素.結論 性彆因素可影響遠隔缺血預處理減輕患者心髒手術後心肌損傷的效果,減輕女性患者心肌損傷的效果優于男性,適噹增加單次缺血時間或總次數可穫得更佳的效果.
목적 채용meta분석평개성별인소화처리책략대원격결혈예처리감경심장수술환자심기손상적영향.방법 이상응관건사계통검색PubMed、EMbase、Cochrane Library수거고(검색시간한정위1990년2월지2012년2월)납입이영문공개발표유관원격결혈예처리재성년환자심장수술중산생심기보호작용적수궤대조시험(RCT).분석술후심기손상표지물수평,계산표준화균차(SMD).채용발표편의화민감성분석판단결과적가신도.채용Stata 12.0연건진행meta분석.결과 납입13편RCT,공985례환자.여대조조비교,원격결혈예처리명현강저환자술후혈청심기손상표지물수평(SMD=-0.539；95％CI:-0.926～-0.152；P＜0.05),구유명현이질성(I2=88.7％；P＜0.01).차결과불존재명현적발표편의(P=0.083,Begg검험；P=0.077,Egger검험),차민감성분석현시매개독립적연구대총효응척도적폭도화방향무명현영향(P＞0.05),결과가신도교고.meta분석결과현시남성(％,회귀계수=0.02;95％CI:-0.002 ～ 0.042；P＜0.1；교정R2=19.61％)화총결혈시간(min,회귀계수=-0.08;95％CI:-0.154 ～0.002;P＜ 0.1;교정R2=19.47％)시영향원격결혈예처리감경심장수술환자심기손상적인소.결론 성별인소가영향원격결혈예처리감경환자심장수술후심기손상적효과,감경녀성환자심기손상적효과우우남성,괄당증가단차결혈시간혹총차수가획득경가적효과.
Objective To evaluate the effect of gender and treatment strategy on remote ischemic preconditioning (RIPC)-induced reduction of myocardial damage in patients undergoing cardiac surgery.Methods We systematically searched the literature in PubMed,EMBase,and Cochrane Library (from Feb 1990 to Feb 2012) using the related keywords.Randomized control trials (RCTs) published in English with report on postoperative biomarkers of myocardial damage concerning RIPC-induced myocardial protection in adult patients undergoing cardiac surgery were included.Standardized mean difference (SMD) was calculated.Publication bias and sensitivity analysis were used to evaluate the reliability of overall enzymatic estimate.Meta-regression analysis was performed to explore the potential sources of significant heterogeneity among results of studies.Data were analyzed using Stata 12.0.Results Thirteen RCTs involving 985 patients were included in our study.Compared with controls,RIPC significantly reduced postoperative serum levels of biomarkers of myocardial damage with significant heterogeneity (SMD=-0.539; 95％CI:-0.926to-0.152; P＜0.05; I2 =88.7％,P＜0.01).No evidence of obvious publication bias was observed (P =0.083,Begg' s test; P =0.077,Egger' s test).Sensitivity analysis showed that each individual study produced no effect on the direction and magnitude of the overall effect size (P ＜ 0.05).Meta-regression analysis revealed that male (％) (coefficient =0.02 ; 95 ％ CI:-0.002-0.042 ; P =0.070 ; adjusted R2 =19.61％) and total ischemic time (min) (coefficient=-0.08; 95％CI:-0.154-0.002; P =0.055; adjusted R2 =19.47％) were the two major influential factors.Conclusion Gender affects RIPC-induced reduction of myocardial damage after cardiac surgery in patients,RIPC-induced reduction of myocardial damage infemale patients is superior to that in male patients and a better efficacy can be achieved by prolonging the single ischemic time or by increasing the ischemic cycles.
