心脏不停跳与停跳二尖瓣置换术患者临床恢复情况比较的Meta分析

The clinical recovery of beating heart versus arrested heart techniques for mitral valve replacement surgery： a Meta-analysis

目的 系统评价心脏不停跳与停跳二尖瓣置换术患者临床恢复情况的差异。 方法 采用Cochrane系统评价方法，计算机检索the Cochrane Library、PubMed、EMBASE、CNKI和万方数据库，收集有关心脏不停跳与停跳二尖瓣置换术临床疗效对比的临床随机对照试验（randomized controlled trial, RCT），检索时限均以上述数据库建库之日起至2016年12月。由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量，然后采用RevMan 5.3软件进行Meta分析。 结果 最终纳入7项RCT，共242例患者，其中不停跳组116例，停跳组126例。Meta分析结果显示，不停跳组CPB时间［加权均数差（weighted mean differences， WMD）=-13.29，95%CI（-21.97，-4.61），P＜0.05］、术中除颤次数［比值比（odds ratio， OR）=0.10, 95%CI（0.03，0.29），P＜0.05］、术后血管活性药物使用量［WMD=-2.71，95%CI（-3.10，-2.32），P＜0.05］及ICU停留时间［WMD=-7.73，95%CI（-10.92，-4.54），P＜0.05］均少于停跳组。但两组手术时间［WMD=-9.69，95%CI（-26.15，6.78），P=0.25］、机械通气时间［WMD=-4.39，95%CI（-10.01，1.23），P=0.13］、术后住院时间［WMD=-1.12，95%CI（-2.24，0.01），P=0.05］以及住院期间死亡人数［OR=2.48，95%CI（0.34，18.11），P=0.37］差异无统计学意义。 结论 在二尖瓣置换术的患者临床恢复情况中，心脏不停跳手术的CPB时间、术中除颤次数、术后血管活性药物使用量及ICU停留时间优于心脏停跳手术，但两者的手术时间、机械通气时间、术后住院时间及住院期间死亡人数并无差异。

Objective To systemically evaluate the clinical recovery differences between beating heart surgery and arrested heart surgery during mitral valve replacement. Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers（CCTR） of the Cochrane Library, PubMed, EMBASE, CNKI and Wanfang databases concerning the comparison of clinical recovery of beating heart surgery and arrested heart surgery during mitral valve replacement from inception to December 2016. Two reviews independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. Then, Meta-analysis was performed using RevMan 5.3 software. Results Seven original randomized controlled trial （RCT） investigated a total of 242 patients, of whom 116 received beating heart surgery and 126 received arrested heart surgery, which met the inclusion criteria. Meta analysis results show that the frequency of defibrillation during operation [odds ratio（OR）=0.10, 95%CI（0.03, 0.29）, P〈0.05] and usage of vasoactive agents after operation [weighted mean differences（WMD）=-2.71, 95%CI（-3.10, -2.32）, P〈0.05] were less in beating heart surgery. In addition, the CPB time [WMD=-13.29, 95%CI（-21.97, -4.61）, P=0.003] and length of ICU stay [WMD=-7.73, 95%CI（-10.92, -4.54）, P〈0.05] were shorter in beating heart surgery, as compared to the arrested heart surgery. However, there were no significant differences between the two groups in operative time [WMD=-9.69, 95%CI（-26.15, 6.78）, P=0.25], mechanical ventilation time [WMD =-4.39, 95%CI（-10.01, 1.23）, P=0.13], post-operatively hospital stay [WMD=-1.12, 95%CI（-2.24, 0.01）, P=0.05] and death toll during hospital stay [OR=2.48, 95%CI（0.34, 18.11）, P=0.37]. Conclusions During mitral valve replacement, the clinical recovery of beating heart surgery is better than recovery of arrested heart surgery in the frequency of defibrillation, usage of vasoactive agents after operation, CPB time and length of ICU stay. But the operative time, mechanical ventilation time, post-operatively hospital stay and death toll during hospital stay did not show significant differences between the two groups.