冠状动脉旁路移植术围手术期应用阿托伐他汀以预防术后早期房颤发生的系统评价

Early prevention of postoperative atrial fibrillation after coronary artery bypass graft surgery perioperative atorvastatin:System evaluation

目的:探讨冠状动脉旁路移植术围手术期应用阿托伐他汀以预防术后早期发生房颤的疗效。方法:通过检索1999-01-2014-01英国医学会电子全文期刊数据库(BMA)、荷兰医学文摘数据库(Embase)、学术期刊集成全文数据库(ASP)、考克兰图书馆(The Cochrane Library)、西文生物医学期刊文献数据库(EMCC)、美国国立医学图书馆生物医学信息检索系统(Pubmed)、万方数据库(CECDB)、维普中文科技期刊全文数据库(CQVIP)、中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)等数据库内相关的随机对照试验(RCT),对纳入文献的质量进行严格评价和资料提取,使用Stata/SE version 12.0软件对纳入研究进行系统评价。结果:最终纳入7篇RCT,共1 483例患者,其中791例予以阿托伐他汀,692例予以安慰剂对照。系统评价结果显示:相比于使用安慰剂,20mg亚组Cochran's Q检验示P=0.407、I2=0%、RR=0.70、95%CI=(0.55,0.90);40 mg亚组的Cochran's Q检验示P=0.770、I2=0%、RR=0.65、95%CI=(0.51,0.83)。即相比使用安慰剂,每日予以20mg或40mg阿托伐他汀均可降低术后早期的房颤发生率。结论:冠状动脉旁路移植术围手术期应用阿托伐他汀,能够有效降低术后早期发生房颤的概率,其疗效确切,值得临床推广。

Objective：To investigate the effect of early prevention of postoperative atrial fibrillation after coro- nary artery bypass graft surgery perioperative atorvastatin. Method： The related RCTs were collected by searching Pubmed, BMA, EMbase, ASP, The Cochrane Library, EMCC, CBM, CNKI, CECDB, CQVIP, VIP database in 1999 January to 2014 January period. The quality of the included studies was controled by strict appraisal and data extraction, the systematic evaluation was used by Stata/SE version 12 software. Result：Eventually 7 RCTs were included. In a total of 1 483 cases of patients, 791 cases were given atorvastatin, and 692 cases were given placebo. System evaluation results showed that： Compared with placebo, 20 mg subgroup Cochran＇s Q test showed that P=0. 407, 12 =0%,RR=0.70, 95%CI= （0.55, 0.90）; 40 mg subgroup Cochran＇s Q test showed that P：0.770, 12：0%,RR=0.65, 95%CI=（0.51, 0.83）. Compared with placebo, 20 mgor40 mgatorvastatin daily could reduce the incidence of early postoperative atrial fibrillation. Conclusion： Coronary artery bypass grafting perioperative atorvastatin can effectively reduce the risk of early postoperative atrial fibrillation, and worth the clinical promotion.