七氟醚预处理对体外循环下冠状动脉搭桥术患者心肌保护作用的系统评价

Systematic Review of Cardioprotective Effect of Sevoflurane Preconditioning on Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

目的用Meta分析的方法评价七氟醚预处理对体外循环下冠状动脉搭桥术患者的心肌保护作用。方法按照制定的检索策略检索PubMed、EMBASE、中国生物医学数据库等及Cochrane图书馆,文献检索时间为1998-2011年。收集有关七氟醚预处理用于冠状动脉搭桥手术患者的临床随机对照研究,筛选出符合纳入标准的文献,利用RevMan4.2软件对纳入研究结果进行Meta分析。结果共检索到符合条件的文献5篇,包含病例294例。Meta分析结果显示,七氟醚组术后血浆心肌肌钙蛋白T峰值浓度较对照组低(加权均数差为-0.21,95%可信区间为-0.33～-0.09,P<0.05),各研究间存在异质性(P<0.01)。与对照组比较七氟醚组的术后血浆氨基末端脑钠肽前体峰值浓度低、血浆肌酸激酶同工酶浓度低、心脏指数高、不良心血管事件的发生率低。结论七氟醚预处理可对体外循环下冠状动脉搭桥手术患者有明显的心肌保护作用。

Objective To systematically assess the cardioprotective effect of Sevoflurane preconditioning on patients undergoing coronary artery bypass grafting with cardiopulmonary bypass using recta-analysis. Methods Randomized controlled trials of Sevoflurane preconditioning on patients undergoing coronary artery bypass grafting were identified from PubMed, EMBASE, CBMdisc, and Cochrane Library from 1998 to 2011. Data were evaluated and extracted by two reviewers independently with inclusion criteria. Data from randomized controlled trials were entered and analysed with RevMan 4.2 software. Results Five studies that recruited 294 patients were included for meta- analysis. Meta-analysis showed that in Sevoflurane group, postoperative peak cardiac troponin T（cTnT） concentrations was lower than control group [the weighted mean differences （WMD） was -0.21, 95%confidence interval was （-0.33, -0.09）, P〈0.05], among these studies there was a significant heterogeneity（P〈0.01）. In Sevoflurane group, peak postoperative N-terminal pro-brain natriuretic peptide （NT-ProBNP） concentrations and creatine kinase-MB （CK-MB） activity were lower, cardiac index （CI） were higher, the rate of postoperative adverse cardiac events were lower compared with control group. Conclusions Sevoflurane preconditioning exerts cardioprotective effect on patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.