远隔缺血预处理联合不同麻醉方式对缺血-再灌注心肌损伤影响的Meta分析

Remote ischemic preconditioning combined with different anesthesia methods effect myocardial ischemiareperfusion injury:a meta-analysis of randomized controlled trials

目的系统评价心血管手术中远隔缺血预处理(RIPC)联合不同麻醉方式对缺血-再灌注心肌损伤(IRI)的影响。方法检索PubMed、Embase、Cochrane Library数据库,根据纳入、排除标准检出相关随机对照研究文献。采用RevMan 5.3及STATA 12.0软件进行Meta分析。结果纳入研究10篇,共969例患者。RIPC可以减少术后肌钙蛋白峰值水平[SMD=-0.16,95%CI(-0.29,-0.03)]。单个协变量Meta回归分析显示女性占比、年龄和β受体阻断药与研究间异质性有关,肌钙蛋白种类、糖尿病、高血压、高脂血症等未对异质性造成影响。以麻醉维持期间药物使用分组:吸入性麻醉药组:SMD=-0.40,95%CI(-0.66,-0.14),吸入性麻醉药复合丙泊酚组:SMD=-0.04,95%CI(-0.20,0.12),丙泊酚组:SMD=-0.29,95%CI(-0.87,0.30)。术后转归(ICU时间、通气时间、强心药使用、房颤发生、住院时间)差异无统计学意义。结论联合使用RIPC与吸入性麻醉药可以降低心血管术后肌钙蛋白释放峰值,但对术后转归无明显影响。

Objective To evaluate the efficacy of remote ischemic preconditioning（RIPC）combined with different anesthesia methods on myocardial ischemia-reperfusion injury（IRI）in cardiovascular surgery.Methods The following databases as PubMed,Embase,and Cochrane Library were searched electronically.The literatures were selected according to the inclusive and exclusive criteria.The data were extracted and then processed using RevMan 5.3 and STATA 12.0 software.Results A total of 10 studies representing 969 patients were included.Combined RIPC and inhaled anesthetics could reduce troponin peak level postoperative[SMD=-0.16,95%CI（-0.29,-0.03）].Univariate Meta-regression analysis suggested that the major sources of significant heterogeneity were female（%）,age,βblockers（%）（P〈0.05）,rather than the species of troponin,diabetes（%）,hypertension（%）,hyperlipidemia（%）.The subgroup analyses were based on the drug using during maintenance：Group inhaled anesthetics：SMD=-0.40,95%CI（-0.66,-0.14）,Group inhaled anesthetics and propofol：SMD=-0.04,95% Cl（-0.20,0.12）,Group propofol：SMD=-0.29,95%Cl（-0.87,-0.30）.The postoperative clinical indicators（ICU time,ventilative time,inotropic agent,atrial fibrillation,hospital stay）were no significant differences.Conclusion The combination of RIPC and inhaled anesthetics could reduce the peak of troponin level after cardiovascular surgery.There were no differences onthe postoperative clinical indicators.