CAJ | 학술논문

器官移植%器官移植循证医学%冠状动脉粥样硬化性心脏病%冠心病%非体外循环冠状动脉旁路移植术%冠状动脉旁路移植术%非体外循环%高危%并发症%房颤%心肌梗死%Meta 分析%其他基金器官移植%器官移植循證醫學%冠狀動脈粥樣硬化性心髒病%冠心病%非體外循環冠狀動脈徬路移植術%冠狀動脈徬路移植術%非體外循環%高危%併髮癥%房顫%心肌梗死%Meta 分析%其他基金
기관이식%기관이식순증의학%관상동맥죽양경화성심장병%관심병%비체외순배관상동맥방로이식술%관상동맥방로이식술%비체외순배%고위%병발증%방전%심기경사%Meta 분석%기타기금

背景:非体外与体外循环冠状动脉旁路移植是治疗冠状动脉粥样硬化性心脏病的外科学方法,但目前尚无二者对高危冠心病患者疗效比较的系统评价.目的:通过 Meta 分析评价非体外与体外循环冠状动脉旁路移植对高危冠心病患者围手术期的疗效和安全性差异.方法:计算机检索 PubMed、EMbase、中国期刊全文数据库、中国生物医学文献数据库、维普数据库、万方数据库和 Cochrane Library(2012年第8期),并辅以检索相关文献的参考文献,语种限制为中文和英文,检索时间为1993年1月至2012年6月.严格按照纳入和排除标准进行筛选研究.由2位评价员独立对纳入的研究进行质量评价与提取资料并交叉核对,最后将提取的资料用 RevMan 5.1软件进行数据处理与分析.结果与结论:共纳入16个研究包括2个随机对照试验与14个观察性研究;共6441例患者,其中非体外循环冠状动脉旁路移植组2948例患者,常规体外循环下冠状动脉旁路移植组3493例患者.Meta 分析结果显示:非体外循环冠状动脉旁路移植与常规体外循环下冠状动脉旁路移植比较,在围手术期脑卒中、主动脉内球囊反搏使用、再发心肌梗死、呼吸功能不全与死亡率,呼吸机辅助时间、ICU 时间、住院时间,输血量及术后引流量方面的差异均有显著性意义,而在房颤、急性肾功能损伤、伤口感染及二次开胸率方面的差异均无显著性意义.结果提示,在围手术期方面与常规体外循环下冠状动脉旁路移植相比,对高危冠心病患者采用非体外循环冠状动脉旁路移植是安全有效的,且具有创伤少,手术死亡率低,术后恢复快,术后并发症少的优点,但是由于纳入文献数量有限且大多为非随机对照试验,因此非体外循环冠状动脉旁路移植并不能取代常规体外循环下冠状动脉旁路移植,其具体疗效与中远期疗效需要进一步通过更高质量、大样本量、多中心的随机双盲对照试验研究及长期的观察才能得出肯定的结论. 揹景:非體外與體外循環冠狀動脈徬路移植是治療冠狀動脈粥樣硬化性心髒病的外科學方法,但目前尚無二者對高危冠心病患者療效比較的繫統評價.目的:通過 Meta 分析評價非體外與體外循環冠狀動脈徬路移植對高危冠心病患者圍手術期的療效和安全性差異.方法:計算機檢索 PubMed、EMbase、中國期刊全文數據庫、中國生物醫學文獻數據庫、維普數據庫、萬方數據庫和 Cochrane Library(2012年第8期),併輔以檢索相關文獻的參攷文獻,語種限製為中文和英文,檢索時間為1993年1月至2012年6月.嚴格按照納入和排除標準進行篩選研究.由2位評價員獨立對納入的研究進行質量評價與提取資料併交扠覈對,最後將提取的資料用 RevMan 5.1軟件進行數據處理與分析.結果與結論:共納入16箇研究包括2箇隨機對照試驗與14箇觀察性研究;共6441例患者,其中非體外循環冠狀動脈徬路移植組2948例患者,常規體外循環下冠狀動脈徬路移植組3493例患者.Meta 分析結果顯示:非體外循環冠狀動脈徬路移植與常規體外循環下冠狀動脈徬路移植比較,在圍手術期腦卒中、主動脈內毬囊反搏使用、再髮心肌梗死、呼吸功能不全與死亡率,呼吸機輔助時間、ICU 時間、住院時間,輸血量及術後引流量方麵的差異均有顯著性意義,而在房顫、急性腎功能損傷、傷口感染及二次開胸率方麵的差異均無顯著性意義.結果提示,在圍手術期方麵與常規體外循環下冠狀動脈徬路移植相比,對高危冠心病患者採用非體外循環冠狀動脈徬路移植是安全有效的,且具有創傷少,手術死亡率低,術後恢複快,術後併髮癥少的優點,但是由于納入文獻數量有限且大多為非隨機對照試驗,因此非體外循環冠狀動脈徬路移植併不能取代常規體外循環下冠狀動脈徬路移植,其具體療效與中遠期療效需要進一步通過更高質量、大樣本量、多中心的隨機雙盲對照試驗研究及長期的觀察纔能得齣肯定的結論.
배경:비체외여체외순배관상동맥방로이식시치료관상동맥죽양경화성심장병적외과학방법,단목전상무이자대고위관심병환자료효비교적계통평개.목적:통과 Meta 분석평개비체외여체외순배관상동맥방로이식대고위관심병환자위수술기적료효화안전성차이.방법:계산궤검색 PubMed、EMbase、중국기간전문수거고、중국생물의학문헌수거고、유보수거고、만방수거고화 Cochrane Library(2012년제8기),병보이검색상관문헌적삼고문헌,어충한제위중문화영문,검색시간위1993년1월지2012년6월.엄격안조납입화배제표준진행사선연구.유2위평개원독립대납입적연구진행질량평개여제취자료병교차핵대,최후장제취적자료용 RevMan 5.1연건진행수거처리여분석.결과여결론:공납입16개연구포괄2개수궤대조시험여14개관찰성연구;공6441례환자,기중비체외순배관상동맥방로이식조2948례환자,상규체외순배하관상동맥방로이식조3493례환자.Meta 분석결과현시:비체외순배관상동맥방로이식여상규체외순배하관상동맥방로이식비교,재위수술기뇌졸중、주동맥내구낭반박사용、재발심기경사、호흡공능불전여사망솔,호흡궤보조시간、ICU 시간、주원시간,수혈량급술후인류량방면적차이균유현저성의의,이재방전、급성신공능손상、상구감염급이차개흉솔방면적차이균무현저성의의.결과제시,재위수술기방면여상규체외순배하관상동맥방로이식상비,대고위관심병환자채용비체외순배관상동맥방로이식시안전유효적,차구유창상소,수술사망솔저,술후회복쾌,술후병발증소적우점,단시유우납입문헌수량유한차대다위비수궤대조시험,인차비체외순배관상동맥방로이식병불능취대상규체외순배하관상동맥방로이식,기구체료효여중원기료효수요진일보통과경고질량、대양본량、다중심적수궤쌍맹대조시험연구급장기적관찰재능득출긍정적결론.
BACKGROUND: Off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting are the two surgical methods for the treatment of coronary atherosclerotic heart disease, but there is no systematic review on the comparison of these two methods in the treatment of high-risk coronary heart disease. OBJECTIVE: To assess the effect and safety of off-pump versus on-pump coronary artery bypass grafting in perioperative period of high-risk coronary heart disease through Meta analysis. METHODS: Relevant clinical trials published in English and Chinese from January 1993 to June 2012 were searched in PubMed database, EMbase database, China National Knowledge Infrastructure database, China Biomedicine Literature database, VIP database, Wanfang database and Cochrane Library (Issue 8, 2012). Manual searches of bibliographies were also performed. Al the clinical trials were selected and analyzed according to the inclusion and exclusion criteria. Two reviewers independently selected eligible trials, performed quality assessment, and cross-checked each other. Final y, the abstracted relevant data was processed and analyzed with software RevMan 5.1. RESULTS AND CONCLUSION: A total of 16 studies, including two randomized control ed trials and 14 retrospective studies were identified. A total of 6 441 high-risk patients, involving 2 948 in the off-pump coronary artery bypass grafting group and 3 493 in the on-pump coronary artery bypass grafting group were included. The results of Meta-analyses showed the differences of stroke, the intra-aortic bal oon counterpulsation using, recurrent myocardial infarction, respiratory dysfunction and mortality incidence in the perioperative period, the ventilation time, the time in intensive care unit, hospitalization time, postoperative drainage and blood transfusion were significant between off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting patients. While there were no statistical differences in atrial fibril ation, acute renal injury, wound infection and reoperation rate. Compared with on-pump coronary artery bypass grafting in the perioperative period, using off-pump coronary artery bypass grafting for high-risk patients is safe and effective with the advantages of less trauma, lower operative mortality, rapider postoperative recovery and fewer complications, but because of the limited number of included studies and most is the non-randomized control ed trials, off-pump coronary artery bypass grafting cannot replace on-pump coronary artery bypass grafting. However, the results and long-term efficacy stil need to be confirmed by higher-quality, more multi-center, large-sample and randomized double-blind control ed trials in the future.