成人心脏手术应用晶体与含血停搏液心肌保护效果比较的meta分析

Comparison of the cardioprotection between crystalloid and blood cardioplegia in adult patients undergoing cardiac surgery： a meta.analysis

目的比较晶体停搏液与含血停搏液在成人心脏手术心肌保护的效果，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（2011年第3期）、MEDLINE、EMBase、PubMed、HighWire、中国生物医学文献数据库（CBM）及中国期刊全文数据库（CNKI）等中外生物医学数据库，收集关于比较晶体与含血停搏液在成人心脏手术中心肌保护的效果的临床随机对照试验，检索日期为1985年1月至2011年12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RevMan5．1软件进行meta分析。结果纳入16项研究，共计3934例患者，其中含血停搏液组2004例，晶体停搏液组1930例。各研究间无统计学异质性，采用固定效应模型。Meta分析显示：晶体停搏液与含血停搏液组在术后30d病死率（OR=1．11，95％CI：0．59～2．08，P=0．74）、术后低心排血量综合征发生率（OR=0．98，95％CI：0．41～2．33，P=0．85）、围手术期心肌梗死发生率（OR=0．85，95％CI：0．55—1．29，P=0．44）、术后正性肌力药物使用率（OR=1．05，95％CI：0．81—1．38，P=0．70）方面，差异均无统计学意义。结论在中低风险择期成人心脏手术中，含血停搏液与晶体停搏液心肌保护效果无差异。

Objectives To compare the cardioprotection effect between blood and crystalloid cardioplegia during cardiac surgery in adult patients , and provide a theoretical basis for optimal myocardial protection strategies. Methods A recta-analysis of randomized controlled trials （RCT） studies about comparing blood and crystalloid cardioplegia in adult patients undergoing cardiac surgery were performed. Cochrane library（ Issue 3,2011 ） , MEDLINE, EMBase, PubMed, HighWire, CBM and CNKI were searched from January 1985 to December 2011. Studies were assessed according to the Cochrane Handbook for systematic reviews. Data were extracted from these trials and analyzed by RevManS. 1 software. Results Sixteen trials involved 3934 patients were included, 2004 cases were in blood group, and 1930 were in crystalloid group. There was no statistical heterogeneity between studies using a fixed effects model. Meta- analysis indicated that, there were no significant differences between blood and crystalloid group in the incidence of postoperative 30 days mortality （OR = 1.11,95 % CI：0. 59-2. 08, P = 0. 74 ）, the incidence of postoperative low cardiac output （ OR = 0. 98,95 % CI：0. 41-2. 33, P = 0. 85 ）, the incidence of perioperative myocardial infarctions （ OR = 0. 85,95% CI： 0. 55-1.29, P = 0.44 ）, and inotropic support requirement （ OR = 1.05,95% CI： 0. 81-1.38, P = 0. 70 ）. Conclusion The blood cardioplegia is no difference with erystalloid cardioplegia in adult patients undergoing cardiac surgery.