高危病人冠状动脉旁路移植术前预防性应用主动脉内球囊反搏泵的临床效果——Meta分析

Effect of Prophylactic Application of Intra-aortic Balloon Pump Before Coronary Artery Bypass Grafting for High Risk Patients by Meta-analysis

目的 :应用Meta分析的方法评价高危病人冠状动脉旁路移植术(CABG)前预防性应用主动脉内球囊反搏(IABP)泵的疗效。方法:计算机检索PubMed、Embase、Cochrane图书馆,中国期刊全文数据库及维普数据库里比较高危病人CABG术前预防性应用和未应用IABP临床效果的对比研究。文献检索时间从各数据库建库时间至2013-07。根据The Newcastle-Ottawa Scale(NOS)量表评价纳入文献的质量并提取资料。对符合质量标准的对照研究采用Rev Man 5.2进行异质性检验及Meta分析。检出相关文献512篇,根据纳入标准最终入选9篇文献;共入选病例1 386例。术前预防性应用IABP的为试验组共560例,术前未预防性应用IABP的为对照组共826例。结果 :试验组较对照组病人在术后住院死亡率(RR:0.37;95%CI:0.22~0.63)、术后低心排(RR:0.40;95%CI:0.19~0.87)及术后肾功能不全(RR:0.59;95%CI:0.39~0.90)的发生率明显减少,差异具有统计学意义(P分别<0.01、0.02、0.01);试验组较对照组病人重症监护室(ICU)时间[标准均数差(SMD)-0.72;95%CI:-1.13^-0.31;P<0.01]和住院时间(SMD:-0.34;95%CI:-0.68^-0.01;P=0.04)明显缩短;试验组较对照组病人在术后新发心肌梗死(RR:0.88;95%CI:0.66~1.18;P=0.40)和术后卒中(RR:1.05;95%CI:0.59~1.86;P=0.86)的发生率上差异无统计学意义。结论 :高危病人CABG术前预防性应用IABP可能是安全有效的,能够改善心功能,减少术后低心排、肾功能不全等严重并发症的发生,从而降低围术期死亡率,提高高危病人CABG的手术效果。

Objectives： To investigate the effect of prophylactic application of intra-aortic balloon pump （IABP） before coronary artery bypass grafting （CABG） in high risk patients by meta-analysis. Methods： The PubMed, Embase, Cochrane controlled trials register databases, CNKI and VIP databases were searched from the data base establishment to 2013-07. According to Newcastle-Ottawa Scale （NOS）, a total of 512 references were cited and 9 articles with 1386 patients were analyzed using Rev Man 5.2 for meta-analysis. The patients were divided into 2 groups, Prophylactic group, n=560 patients with IABP before CABG and Control group, n=826 patients without IABP before CABG. The comparative study was conduct between 2 groups. Results： Compared with Control group, Prophylactic group showed obviously decreased hospital mortality （RR： 0.37, 95%CI 0.22-0.63）, postoperative low cardiac output syndrome （RR： 0.40, 95%CI 0.19-0.87） and renal dysfunction （RR： 0.59, 95%CI 0.39-0.90）, P〈0.01, P〈0.02 and P〈0.01; significantly shortened 1CU time （SMD： -0.72, 95%CI -1.13--0.31, P〈0.01） and hospitalization time （SMD： -0.34, 95%CI -0.68--0.01, P=0.04）. The incidence of postoperative myocardial infarction （RR： 0.88, 95%CI 0.66-1.18, P=0.04） and neurological complication （RR： 1.05, 95%CI 0.59-1.86, P=0.86） were similar between 2 groups. Conclusion： Prophylactic lABP application before CABG might be safe and effective, it may improve the cardiac function, decrease the postoperative low cardiac output and renal insufficiency, therefore reduce the peri-operative mortality in the high risk patients.