围手术期输注红细胞影响冠心病术后疗效的Meta分析

Impact on postoperative outcomes after red blood transfusion in coronary artery bypass graft surgey： a meta-analysis of current evidence

目的系统评价冠状动脉旁路移植术围手术期输注红细胞对术后近、远期治疗效果的影响。方法应用Meta分析方法对入选文献的研究结果进行定量分析；应用Review manager5．3软件进行异质性检验，计算OR值和95％置信区间（CI），行敏感性和发表偏倚分析。结果共纳入7篇文献，所有入选研究均为回顾性病例对照研究，总病例数71228例，其中输注红细胞患者33872例，未输注红细胞患者37356例。术后数据合并OR值分别为：30天病死率OR=1．85（95％CI：1．35-2．54），1年病死率OR=2．02（95％CI：1．44—2．84），脑卒中OR=2．92（95％CI：1．96-4．35），肾衰OR=7．67（95％CI：1．44～40．94），纵隔炎OR=2．26（95％CI：1．72-2．97），心肌梗死OR=3．53（95％CI：2．89-4．29）。结论围手术期输注红细胞可显著增加冠状动脉旁路移植术围手术期并发症发生风险和术后病死率。由于目前文献的局限性，需行高质量的随机对照研究证实此种风险的存在。

Objective To systemically assess impact on postoperative outcomes after red blood cell transfusion（RBCT） in coronary artery bypass graft surgey. Methods A meta-analysis was performed on the comparison and synthesis of findings from included studies published from January 1980 to January 2014. Pooled odds ratio（OR） and 95% confidence interval（CI） were calculated using RevManS. 3 software. Sensitivity analysis was conducted and possible publication bias was tested as well. Results Seven retrospective studies including 71 228 patients（33 872 RBCT cases, 37 356 control cases） were eligible for inclusion. The pooled analysis revealed difference in the 30-day mortality OR = 1.85 （ 95 % CI： 1.35 - 2.54 ）, 1-year mortality OR = 2.02（95% CI：1. 44 -2.84）, shock OR =2.92（95% CI：1. 96 -4.35）, renal dysfunction OR =7.67（95% CI：1. 44 - 40.94）, mediastinitis OR = 2.26 （95 % CI： 1.72 - 2.97 ）, and myocardial infarction OR = 3.53 （ 95 % CI： 2. 89 - 4.29 ）. Conclusion Perioperative RBCT can incresase the risk of postoperative mortality and complications in coronary artery bypass graft surgey. High-quality randomized case cohort studies are still needed for the further proof of the risk.