婴幼儿心脏手术中肢体缺血预处理心肺保护作用的Meta分析

Meta analysis of cardiopulmonary protective effects of limb ischemic preconditioning in infants undergoing cardiac surgery

目的系统评价肢体缺血预处理在婴幼儿心脏手术围术期的心、肺保护作用。方法检索Pubmed、Embase、Cochrane library、CNKI和Wan Fang Data,纳入肢体缺血预处理在婴幼儿心脏手术应用的前瞻性临床试验,每项试验中均包括肢体缺血预处理组(T组)和空白对照组(C组)。主要预后指标为心肌肌钙蛋白I(c Tn I)和肺泡-动脉血氧分压差[P(A-a)O2]。使用CMA 2.0软件进行Meta分析。结果共纳入6篇文献,包括264例心脏手术患者。其中T组133例,C组131例,两组间基线数据均衡。主要预后指标Meta分析结果:术后1~3 h T组c Tn I低于C组(SMD=-0.481,95%CI:-0.762^-0.200,P=0.001),术后4~6 h T组P(A-a)O2低于C组(SMD=-0.297,95%CI:-0.592^-0.003,P=0.048)。两组机械通气时间和重症监护室停留时间比较,差异无统计学意义(P>0.05)。结论肢体缺血预处理可降低婴幼儿心脏术后早期c Tn I和P(A-a)O2,但尚无加快心脏手术婴幼儿术后临床康复的证据。

Objective To evaluate the cardiopulmonary protective effects of limb ischemic preconditioning in infants undergoing cardiac surgery. Methods Pubmed, Embase, Cochrane library, CNKI and Wan Fang Data were searched for prospective clinical trials on limb ischemic preconditioning in infants undergoing cardiac surgery. There were limb ischemic preconditioning group（group T） and blank control group（group C） in every trial. The major outcomes were c Tn I and P（A-a）O2. The meta-analysis was performed with comprehensive Meta analysis（CMA） 2.0. Results Six trials involving 264 patients undergoing cardiac surgery were included. 133 cases of them in group T, while 131 cases in group C. The baseline characteristics were comparable between the two groups. The results of Meta analysis were as follows：The c Tn I in group T was lower than that in group C 1-3 hours after operation（SMD =-0.481, 95%CI：-0.762--0.200,P = 0.001）, and the P（A-a）O2in group T was lower than that in group C 4-6 hours after operation（SMD=-0.297, 95%CI：-0.592--0.003, P = 0.048）. There was no statistically significant difference in duration of mechanical ventilation and ICU stay between the two groups（P〉0.05）. Conclusion Limb ischemic preconditioning can decrease c Tn I and P（A-a）O2of infants undergoing cardiac surgery in the early post-operative stage. But there is no evidence to support that limb ischemic preconditioning can enhance recovery.