HTK液与高钾停搏液在成人心脏手术中心肌保护效果的荟萃分析

Protection Effect of HTK Solution and High Potassium on Myocardium in Adult Cardiac Surgery:A Meta-analysis

目的通过比较成人心脏手术中HTK液和高钾停搏液的心肌保护效果,探讨最佳的心肌保护方法。方法检索主要中外生物医学数据库(2005.10~2016.11)文献,收集HTK液与高钾停搏液心肌保护比较的随机对照研究,以Cochrane系统工具评价纳入研究的偏倚风险,对提取的结局指标进行Meta分析。结果最终纳入研究13篇,共含1 047个病例,其中HTK组(实验组)502例,高钾组(对照组)545例;各组研究经检验无统计学异质性,采用固定模型合并。4项研究比较了两组CK-MB峰值,两组的CK-MB峰值无统计学差异(SMD=0.20,95%CI:-0.06~0.46,P=0.21);4项研究比较了两组30d死亡率,两组的30d死亡率无统计学差异(OR=0.53,95%CI:0.22~1.26,P=0.66);6项研究比较了两组自动复跳率,两组的自动复跳率无统计学差异(OR=1.42,95%CI:0.98~2.07,P=0.12)。结论成人心脏手术中,HTK液与高钾停搏液心肌保护效果无差异。

Objective To explore the ideal myocardial protection strategy by comparing myocardial protection effect of HTK solution and high potassium cardioplegia in adult cardiac surgery.Methods Randomized controlled studies comparing the myocardial protective effects of HTK solution and high potassium on cardioplegia were collected by searching the main Chinese and foreign biomedical databases（2005.10-2016.11）.The risk of bias was assessed by the Cochrane system,and the outcome indicators were analysed by Meta-analysis.Results Finally,13 studies were included,including a total of 1 047 cases,in which502 cases were in HTK group and 545 cases were in high potassium group.There was no statistical heterogeneity in each study,and fixed model combination was used.Four studies compared maximum CK-MB between the two groups,and there was no significant difference（SMD=0.20,95%CI：-0.06-0.46,P=0.21）;4studies compared 30-day mortality between the two groups,the 30-day mortality showed no significant difference（OR=0.53,95%CI：0.22-1.26,P=0.66）;6studies compared the rate of heart beating spontaneously between the two groups,there was no significant difference（OR=1.42,95%CI：0.98-2.07,P=0.12）.Conclusion There is no significant difference in protection effects between HTK solution and high potassium on myocardium in adult cardiac surgery.