七氟烷与丙泊酚对冠脉搭桥患者心肌保护作用的Meta分析

Sevoflurane versus propofol for myocardial protection in patients undergoing coronary artery bypass grafting surgery:a Meta-analysis

目的评价七氟烷与丙泊酚对实施冠脉搭桥术患者的心肌保护作用,为临床实施心肌保护措施提供依据。方法计算机检索PubMed、EMbase、Cochrane图书馆(2014年第5期)、中国知网(CNKI)、中国生物医学网(CBM)、万方数据库(WanFang Data),检索时限为2004年1月-2014年6月,结果采用RevMan5.3软件进行Meta分析。结果纳入13项研究,共计742例患者,Meta分析结果显示,七氟烷与丙泊酚相比具有更好的心肌保护作用,主要表现在肌钙蛋白I含量的降低(WMD=-1.53,95%CI:[-2.41,-0.24],P=0.000 7)、心肌缺血发生率的降低(RR=0.48,95%CI:[0.37,0.62],P<0.000 01)、住院天数的降低(WMD=-1.01,95%CI:[-1.98,-0.05],P=0.04)以及心指数的提高(WMD=0.25,95%CI:[0.10,0.39],P=0.000 7)。结论对实施冠脉搭桥术的患者,七氟烷较丙泊酚更具心肌保护作用,但其可靠性尚待评估,结论尚需更多大样本量随机试验加以验证。

Objective To systematically evaluate the effectiveness of myocardial protection of sevoflurane versus propofolin patientsundergoing coronary artery bypass grafting （CABG） surgery. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 5, 2014）, CNKI, CBM, WanFang Data were searched to collect the randomized controlled trails （RCTs） aboutsevoflurane with propofol for protecting myocardium in patients undergoing CABG surgery. From January 2004 to June 2014 the meta-a- nalysis was conducted using RevMan5.3 software. Results A total of 13 RCTs involving 742 patients were included. Patients randomized into sevoflurane group had higher post-bypasscardiac index （WMD= 0.25, 95% CI ：[0.10, 0.39],P =0.000 7）, lower troponin I level （WMD=-1.53,95% CI ：[- 2,41, - 0.24],P =0.000 7）, lower incidence of myocardial ischemia （RR = 0.48,95% CI：[0.37, 0.62] ,P 〈0.000 01） and shorter hospital stay length （WMD=-1.01,95% CI：[-1.98, -0.05],P =0.04）. Conclusion Current studies is suggested that sevoflurane has bettermyocardial protection than propofol in CABG surgery, however, due to the limited quantity of the included studies, more large multi-centerrandomized studies are needed.