采用Meta分析吸入麻醉药对冠脉搭桥术心肌的保护作用

The effect of inhalation anesthetics on myocardial protection in coronary artery bypass grafting-a meta analysis

目的系统评价吸入麻醉剂对冠状动脉搭桥术（CABG）心肌缺血再灌注损伤的保护作用。方法对1995年1月-2007年12月Medline和CNKI数据库中关于使用吸入麻醉剂对CABG心肌保护的临床随机对照研究的文献进行检索和Meta分析。所选资料为吸入麻醉剂预处理以及吸入麻醉剂和静脉麻醉剂对冠状动脉搭桥术的临床随机对照研究（RCTs）。收集各研究中的心脏指数、使用正性肌力药的例数、术后24 h内心肌肌钙蛋白I（cTnI）、肌酸激酶MB（CK-MB）和脑钠肽（BNP）的最高数值。记数资料采用优势比和95%可信区间表示,计量资料用加权平均值和95%可信区间表示,所有计算和统计用Rev-Man 4.2.10软件完成。结果符合标准的研究共24项,包括1470例病人。无论是预处理还是与静脉麻醉相比,吸入麻醉剂都能使CABG病人术后的心脏指数增加[WMD,0.41;95%CI（0.17,0.64）],能明显降低术后cTnI[WMD,-1.61;95%CI（-2.25,-0.96）]、CK-MB[WMD,-11.9;95%CI（-20.76,-3.04）]和BNP[WMD,-2.34;95%CI（-3.08,-1.61）]水平,减少术后正性肌力药的用量[OR,0.45;95%CI（0.35,-0.58）]。结论吸入麻醉剂用于冠状动脉搭桥术具有明显的心肌保护作用。

Objective To investigate the effect of inhalation anaesthetics on myocardial protection during coronary artery bypass graft（CABG） surgery.Methods Data were obtained from searches of MEDLINE,CNKI and references listed.It was undertook that only randomized controlled trials（RCTs） evaluating inhalaton anesthetics（enflurane,sevoflurane,isoflurane and deflurane） and intravenous anesthetic drugs（propofol and midazolam） or inhalation anesthetics preconditioning during CABG were included.Data were Abstracted on Cardiac Index,Inotropic Support,and the peak value of Troponin I,CK-MB and Brain Natriuretic Peptide（BNP） during the postoperative period of 48 hours.The weighted mean difference（WMD） with 95% CI for continuous data and odds ratio（OR） with 95% confidence intervals（CI） for binary data were calculated.Statistical analyses were performed using RevMan 4.2.10.Results Twenty-four trials,1470 patients included,were identified.There were higher cardiac index [WMD,0.41;95%CI（0.17,0.64）],significantly lower serum concentrations of both troponin I [WMD,-1.61;95% CI（-2.25,-0.96）] and CK-MB [WMD,-11.9;95%CI（-20.76,-3.04）] as well as BNP[WMD,-2.34;95%CI（-3.08,-1.61）]and lesser requirement for inotropic support[OR,0.45;95%CI（0.35,-0.58）] in the patients randomized to receive volatile anaesthetics compared with those received i.v.anaesthetics. Conclusion It is found that volatile anaesthetic agents provide myocardial protection in CABG surgery,but larger adequately powered trials with agreed,defined outcomes need to be done to fully assess a possible beneficial effect of volatile anaesthetic agents on the morbidity and mortality.