缺血预处理对心内直视手术患者的心肌保护效应：meta分析

Myocardial protective effect of ischemic preconditioning in patients undergoing open heart surgery ： a metaanalysis

目的采用meta分析评价缺血预处理对心内直视手术患者的心肌保护效应。方法检索PubMed、EMBASE、Highwire、CENTREN及其下属各临床注册试验数据中心、中国生物医学文献数据库和中国期刊全文数据库，收集全身麻醉下缺血预处理对心内直视手术患者的心肌保护效果的随机对照研究。采用Cochrane系统评价法评价所纳入文献的质量，评价指标包括：术后心源性死亡率、心肌梗死发生率、室性心律失常发生率和正性肌力药物使用率。采用RevMan5．0软件进行Meta分析。结果纳人12项研究，8项研究为高等质量文献，4项研究为中等质量文献，共626例患者。缺血预处理可降低心内直视手术患者术后室性心律失常发生率和正性肌力药物使用率（P〈0．05），而对术后心源性死亡率及心肌梗死发生率无影响（P〉0．05）。结论缺血预处理可降低心内直视手术患者术后室性心律失常的发生，而对术后心源性死亡和心肌梗死发生没有影响。

Objective To systematically review the myocardial protective effect of ischemic preconditioning in patients undergoing open heart surgery.Methods PubMed, EMBASE, Highwire, CENTREN and its affiliated clinical trial registration data center, CBM and CNKI were searched to identify all randomized controlled trials involving the myocardial protective effect of ischemic preconditioning in patients undergoing open heart surgery under general anesthesia. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Evaluation indexes included the incidences of postoperative cardiac death, myocardial infarction and ventricular arrhythmias and postoperative inotropic drug requirement. Meta-analysis was conducted using the Cochrane Collaboration＇s RevMan 5.0 software. Results Twelve randomized controlled trials （8 high-quality trials and 4 medium-quality trials） involving 626 patients were included in our Meta-analysis. Meta-analysis indicated that ischemic proconditioning significantly reduced the incidence of postoperative ventricular alThythmias and postoperative inotropic drug requirement （ P 〈 0.05） and had no effect on the incidences of postoperative cardiac death and myocardial infarction （ P 〉 0.05）. Conclusion Ischemie preconditioning can reduce the postoperative ventricular arrhythmias and have no effect on postoperative cardiac death and myocardial infarction in patients undergoing open heart surgery.