不同剂量糖皮质激素预防患者冠状动脉旁路移植术后并发症的效果：meta分析

Efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients under- going coronary artery bypass grafting： a meta-analysis

目的采用meta分析评价不同剂量糖皮质激素预防患者冠状动脉旁路移植术后并发症的效果。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，检索时间限定2000年至2010年。收集冠状动脉旁路移植术患者给予不同剂量糖皮质激素预防术后并发症的随机对照研究。采用Cochrane协作网系统评价文献质量，并分析有关资料，主要包括术后房颤的发生情况、术后因高血糖需胰岛素治疗的情况、术后感染发生情况、术后死亡情况（住院期间或出院30d内）和机械通气时间。采用RevMan5．1软件进行meta分析。结果纳入21项研究，共1737例患者。冠状动脉旁路移植术患者给予不同剂量糖皮质激素可降低术后房颤发生的风险，不增加各种原因感染及死亡的风险；中、大剂量增加因高血糖需要胰岛素治疗的风险；大剂量糖皮质激素患者机械通气时间延长。结论冠状动脉旁路移植术患者给予不同剂量糖皮质激素可降低术后房颤的发生风险，且不增加感染和死亡的风险；中、大剂量可增加因高血糖需胰岛素治疗的风险；大剂量可增加机械通气时间延长的风险。

Objective To evaluate the efficacy of different doses of glucocorticoid for prevention of posto- perative complications in patients undergoing coronary artery bypass grafting （CABG）. Methods We searched PubMed, EMBASE, Highwire, CENTREN and its affiliated clinical trial registration data center, Chinese Biomed- ical Database, and CNKI from 2000 to 2010 for randomized controlled trials involving the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing CABG. The quality of the studies was evaluated by the＂ method recommended by Cochrane Collaboration. Evaluation indexes included devel- opment of fibrillation, requirement for insulin treatment because of hyperglycosemia, infection, and death （during stay in hospital or within 30 days after discharge from hospital） after operation and mechanical ventilation time. Meta-analysis was conducted using the RevMan 5.1 software. Results Twenty-one randomized controlled trials in- volving 1737 patients were included in our meta-analysis. Different doses of glueocorticoid decreased the risk of fi- brillation, and did not increase the risk of various causes-induced infection and death. Moderate and large doses of glucocorticoid increased the risk of requirement for insulin treatment because of hyperglucosemia. Large dose of glucocortieoid resulted in prolongation of ventilation time. Conclusion Different doses of glucocorticoid can de- crease the development of postoperative fibrillation without increasing the risk of infection and death, moderate and large doses of glucoeorticuid increase the risk of requirement for insulin treatment because of hyperglucosemia and large dose of glucocorticoid increases the risk of prolonged ventilation time in patients undergoing CABG.