米力农对行冠状动脉旁路植入术患者心功能影响的Meta分析

The effect of milrinone on cardiacfunctions in patients undergoing coronary artery bypass graft:a meta-analysis

目的:研究米力农对行冠状动脉旁路植入术患者心功能的影响。方法:计算机检索Pub Med、EMBASE、Cochrane Central Registerof Controlled Trials、MEDLINE、CBM、CNKI,全面收集采用米力农治疗行冠状动脉旁路植入术患者的随机对照试验(RCTs),用Revman 5.2软件进行Meta分析。采用比值比和95%可信区间评价米力农对行冠状动脉旁路植入术患者心功能的影响。结果:纳入5项随机对照临床研究,共计282例行冠状动脉旁路植入术患者。Meta分析结果表明:米力农可降低行冠状动脉旁路植入术患者心肌缺血发生率相对危险度(OR=0.23,95%CI:0.12~0.44;P<0.0001)、心肌梗死发生率(OR=0.27,95%CI:0.11~0.62;P=0.002)、心律不齐发病率(OR=0.39,95%CI:0.19~0.82;P=0.01);可缩短正性肌力药给药时长(MD=-4.10,95%CI:-6.52^-1.68;P=0.000 9)和机械通气时长(MD=-2.84,95%CI:-5.00^-0.69;P=0.010)。但对需行主动脉内球囊反搏术(OR=0.36,95%CI:0.12~1.03;P=0.06)、需用正性肌力药(OR=1.18,95%CI:0.62~2.24;P=0.62)、ICU住院时长(MD=-0.16,95%CI:-0.52~0.19;P=0.37)、死亡率(OR=0.51,95%CI:0.10~2.55;P=0.42)和肾衰发病率(OR=0.70,95%CI:0.22~2.26;P=0.55)等无影响。结论:米力农可降低行冠状动脉旁路植入术患者心肌缺血发生率、心肌梗死发生率和心律不齐发病率,缩短正性肌力药给药时长和机械通气时长,但对需行主动脉内球囊反搏术、需用正性肌力药、ICU住院时长、死亡率和肾衰发病率等无影响。

Objective： To study the effect of milrinone on cardiac functions in patients undergoing coronary artery bypass graft（ CABG） by this meta-analysis of randomized controlled trials（ RCTs）.Methods： The Pub Med、EMBASE、Cochrane Central Register of Controlled Trials、MEDLINE、CBM、CNKI databases were searched for RCTs.All eligible studies were RCTs assessing the effect of milrinone therapy on cardiac function in patients undergoing CABG.The data were analyzed by Revman5.2 software.Odds Ratios（ ORs） with 95% confidence intervals（ CIs） were used to measure the effect of milrinone on cardiac function.Results： Five RCTs reporting data on 282 patients were finally included.Milrinone could decrease incidence of myocardial ischemia（ OR = 0.23; 95% CI： 0.12 - 0.44; P 0.0001）,myocardial infraction（ OR = 0.27; 95% CI： 0.11 - 0.62;P = 0.002） and morbidity of arrhythemia（ OR = 0.39; 95% CI： 0.19 - 0.82; P = 0.01）.Milrinone could alsodecrease duration of inotropic support（ MD =-4.10; 95% CI：-6.52 --1.68; P = 0.0009） and duration of mechanical ventilation support（ MD =-2.84; 95% CI：-5.00 --0.69; P = 0.010）.However,milrinone had no effect on requirement for intra-aortic balloonpump（ OR = 0.36; 95 % CI： 0.12 - 1.03; P = 0.06）,inotropicsupport（ OR = 1.18; 95 % CI： 0.62 - 2.24; P =0.62）,intensive care unit stay（ MD =-0.16; 95% CI：-0.52 - 0.19; P = 0.37）,overall mortality（ OR = 0.51; 95% CI：0.10 - 2.55; P = 0.42） and morbidity of renal failure（ OR = 0.70; 95% CI： 0.22 - 2.26; P = 0.55）.Conclusion： Milrinone is effective to lower incidence of myocardial ischemia,myocardial infarction and morbidity of arrhythemia in patients post-CABG,and can also decrease duration of inotropic support and duration of mechanical ventilation support.However,it was unable to decrease the requirement for intra-aortic balloon pump,inotropic support,intensive care unit stay,overall mortality and morbidity of renal failure.