含血停搏液与STH液对未成熟心肌保护作用的系统评价

Comparison of the cardioprotection between blood cardioplegia and STH cardioplegia in infant cardiac surgery: a meta-analysis

目的比较含血心脏停搏液与STH液在婴幼儿心脏手术中对心肌保护的效果,为优化心肌保护策略提供理论依据。方法计算机检索Cochrane图书馆(2013年第3期)、MEDLINE、EMBase、PubMed、Springer Link、Science Direct、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)及万方数据库等中外生物医学数据库,收集关于比较含血心脏停搏液与STH心脏停搏液在婴幼儿心脏手术心肌保护的效果的临床随机对照试验,检索日期为建刊至2013年3月。按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan 5.1软件进行meta分析。结果共纳入14项研究。Meta分析显示:含血心脏停搏液与STH心脏停搏液在术后心律失常发生率(OR=0.24,95%CI:0.08,0.76,P=0.02)、住院时间(OR=-1.09,95%CI:-2.03,-0.15,P=0.02)、复跳时间(OR=-73.20,95%CI:-111.65,-34.75,P=0.0002)方面,差异均有统计学意义;在自动复跳率(OR=2.55,95%CI:0.57,11.40,P=0.22)、术后LCOS发生率(OR=0.24,95%CI:0.01,7.60,P=0.41)、呼吸机辅助时间(OR=-0.975,95%CI:-24.00,4.51,P=0.18)方面,差异均无统计学意义。结论含血停搏液对未成熟心肌的保护作用明显优于STH液。但是,由于纳入研究的方法学质量均欠佳,且样本量有限,因此本系统评价结论尚需开展更多设计严谨的高质量、大样本RCT进一步验证,并尽可能延长随访时间,以观察长期疗效。

cardiac surgery in infant patients , and provide a theoretical basis for optimal myocardial protection strategies . Methods A meta-analysis of randomized controlled trials ( RCTs ) studies about comparing blood and STH cardioplegia in infant patients undergoing cardiac surgery were performed .Cochrane library ( Issue 2, 2013 ), MEDLINE,EMBase,PubMed,Springer Link,Science Direct,CBM,CNKI and Wan fang were searched from the initial issiue to March 2013 .Studies were assessed according to the Cochrane Handbook for systematic reviews .Data were extracted from these trials and analyzed by RevMan 5.1 software .Results Fourteen trials were included , Meta-analysis indicated that ,there were significant differences between blood cardioplegia and STH cardioplegia in the incidence of postoperative arrhythmias (OR =0.24,95% CI:0.08,0.76,P=0.02),days in hospital(OR=-1.09,95%CI:-2.03,-0.15,P=0.02),resuscitation time(OR=-73.20,95% CI:-111.65,-34.75,P=0.0002 ) ,but there were no significant differences in the incidence of postoperative auto-beating ( OR=2.55 , 95%CI:0.57 ,11.40 , P=0.22 ) , the incidence of postoperative low cardiac output ( OR=0.24 ,95% CI:0.01 , 7.60,P=0.41)and the hours of ventilation (OR=-0.975,95%CI:-24.00,4.51,P=0.18).Conclusions The current evidence shows that the protective effects of blood cardioplegia on immature myocardium in infants cardiac surgery are obviously better than STH cardioplegia .However,given the low methodological quality and the limited sample size of most included studies ,this conclusion still needs to be further proved by conducting more strictly-designed,high-quality and large-scale RCTs.The long-term effectiveness of those 2 treatment modalities also needs to be observed in a longer follow-up duration .