大血管手术低温停循环下顺、逆行脑灌注的荟萃分析

Antegrade versus Retrograde Cerebral Perfusion during Hypothermic CirculatoryArrest in Aortic Surgery:A Meta-analysis of 6962 Patients

目的比较低温停循环下应用顺行性或逆行性脑灌注进行大血管手术患者的临床结果。方法我们对PubMed,Embase和the Cochrane Library数据库进行了检索。纳入的研究对象要分别采用低温停循环(HCA)+顺行性脑灌注(ACP)和低温停循环(HCA)+逆行性脑灌注行(RCP)进行大血管手术,并且研究报道了早期死亡率、中风率、短暂性神经功能障碍(TND)、永久性神经功能障碍(PND)中至少一个作为临床终点的原始数据。我们通过Q检验和I2检验进行异质性分析,运用Begg’s检验和Egger’s检验分析有无出版偏倚。结果最终有31篇文章纳入此荟萃分析,其中4300名患者使用HCA+ACP,2662名使用HCA+RCP。TND的合并RR为0.806,95%CI=[0.640,1.015],Z值为1.84(p=0.066).PND的合并RR为0.974,95%CI=[0.713,1.332],Z值为0.16(p=0.87)。早期死亡率的合并RR为1.152,95%CI=[0.935,1.420],Z值为1.33(p=0.185)。中风结果的合并RR为1.393,95%CI=[0.755,2.569],Z值为1.06(p=0.288)。结果显示各组间均无显著性差异。结论大血管手术中运用HCA+ACP或HCA+RCP在比较TND,PND,早期死亡率和中风率这些临床终点时没有显著统计学差异。

Objective To compare neurologic outcomes and early mortality between ACP and RcP in patients who underwent aortic surgery during DHCA. Methods PubMed, Embase. and the Cochrane Library were searched for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction （TND） and permanent neurologic dysfunction （PND） in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed by the Cochrane Q statistic and 12 statistic. Publication bias was tested by Begg＇s funnel lot and Egger＇s test. Results Thirty-one studies were included in this recta-analysis, with 4300 patients employing DHCA＋ACP and 2662 utilizing DHCA ＋ RCP. The overall pooled relative risk （RR） Ibr TND was 0.806, 95% CI = [0.640, 1.015], and the z score for overall effect was 1.84 （p=0.066）. The overall pooled RR for PN D was 0.974, 95% CI = [0.713, 1.332], and the z-score for overall effect was 0.16 （p=0.87）. The overall pooled RR for early mortality was 1.152, 95% CI= [0.935, 1.420], and the z-score for overall effect was 1.33 （p=0.185）. The overall pooled RR for stroke was 1.393, 95% CI = [0.755, 2.569], and the z-score fbr overall effect was 1.06 （p=0.288）. There were no significant differences between groups in PND, TND, stroke and early mortality. Conclusions This meta-analysis indicates that DHCA ＋ ACP and DHCA＋RCP got similar results in terms ofTND, PND, early mortality and stroke in aortic surgery.