高危患者行非体外循环与体外循环冠状动脉旁路移植术效果及安全性的Meta分析

The comparation of OPCABG and CCABG in perioperative period of high-risk coronary heart disease:a meta-analysis

目的本文采用循证医学方法系统评价高危患者行非体外循环冠状动脉旁路移植术(OPCABG)与传统的体外循环冠状动脉旁路移植术(CCABG)效果和安全性。方法计算机广泛检索Cochrane图书馆、Pubmed、MEDLINE、EMBASE、万方数据库、中国知网、维普数据库中从建库到2015年6月发表的关于非体外循环与体外循环冠状动脉旁路移植术治疗高危患者效果和安全性的文献。对纳入研究的质量进行严格评价与提取资料,对符合标准的文献进行Meta分析。统计学分析应用Rev Man 5.2软件。结果纳入8个研究共计2 789例患者。Meta分析结果显示:(1)有效性:非体外循环组(OPCABG组)围术期死亡率低于体外循环组(CCABG组),且差异有统计学意义(OR=0.42,95%CI:0.25~0.68);与CCABG组相比,OPCABG组术后机械通气时间、ICU治疗时间及住院时间均有缩短,差异有统计学意义(MD=-5.16,95%CI:-8.19^-2.12;MD=-0.82,95%CI:-1.27^-0.37;MD=-2.14,95%CI:-2.63^-1.64),而两组手术时间及术中主动脉内球囊反搏(IABP)的使用率差异无统计学意义;(2)安全性:OPCABG组术后并发症总发生率、休克、心梗、肾功能损害的发生率均低于CCABG组差异有统计学意义(OR=0.50,95%CI:0.35~0.72;OR=0.38,95%CI:0.21~0.70;OR=0.56,95%CI:0.35~0.91;OR=0.50,95%CI:0.35~0.72);术后二次开胸止血、房颤的发生率差异无统计学意义。结论现有临床证据表明,OPCABG治疗冠状动脉病变比CCABG治疗效果和安全性更好。

Objective This article systematically evaluates the effect and safety of off-pump coronary artery bypass grafting（OPCABG）versus on-pump/conventional coronary artery bypass grafting（CCABG）in perioperative period of high-riskcoronary heart disease. Methods An extensive search was performed within The Cochrane library,Pubmed,MEDLINE,EMBASE,Wanfang Data,CINK,VIP up to June of 2015 about the effect and safety of off-pump versus on-pump coronaryartery bypass grafting in perioperative period of high-risk coronary heart disease. The selected studies were evaluated strictlyand the extracted data were analyzed by Rev Man 5.2. Results A total of 8 studies,involving 2 789 patients met theinclusion criteria. The results of meta-analyses showed that：（1）Efficacy：The mortality incidence in the perioperative periodwas significantly lower in OPCABG group than these in CCABG group[OR（95%CI）were 0.42（0.25-0.68）,respectively].The postoperative duration of mechanical ventilation,postoperative length of ICU stay and postoperative length of hospitalstay in OPCABG group were notably shorter than those in CCABG group[MD（95%CI）were-5.16（-8.19--2.12）,-0.82（-1.27--0.37）and-2.14（-2.63--1.64）,respectively],but there was no significant difference between the average operationtime and the usage rates of intra-aortic balloon pump（IABP）.（2）Safety：The incidence of postoperative shock,myocardialinfarction and renal function injuryin OPCABG group was lower than those in CCABG group[OR（95%CI）were 0.38（0.21-0.70）,0.56（0.35-0.91）and 0.50（0.35-0.72）,respectively],while there were no statistical differences in atrial fibrillationand incidence of re-thoratomy for hemaostsis. Conclusions Compared with CCABG in the perioperative period,usingOPCABG for high-risk patients was more safe and effective. However,due to the included non-randomized controlled trials,OPCABG could replace CCABG;more large-sample,high-quality RCTs were required for further verification.