摘要
背景:已有一些小样本、随机对照试验对血液及晶体心脏停搏液在心脏外科手术中的心肌保护疗效进行了对比评价。血液停搏液提供了更接近正常生理的保护措施,其临床收益也显而易见。此项荟萃分析对血液停搏液在减少术后不良结果方面的作用进行了阐述。方法和结果:检索来自MEDLINE、EMBASE以及Cochrane对照试验注册的临床试验。该检索仅限于在成人患者中比较血液及晶体停搏液并以英文出版的随机对照试验。每项试验均由两位研究者采用盲法仔细评估和概括。
BACKGROUND -Many small, randomized, controlled trials have evaluated the effectiveness of blood as compared with crystalloid cardioplegia for myocardial protection during cardiac surgery. Blood cardioplegia provides a closer approximation to normal physiology, which may translate into measurable clinical benefits. This meta-analysis describes the effectiveness of blood cardioplegia in lowering adverse postoperative outcomes. METHODS AND RESULTS -MEDLINE, EMBASE, and the Cochrane registry of controlled trials were searched for clinical trials. The search was restricted to peer-reviewed English language publications of randomized controlled trials that primarily compared blood and crystalloid cardioplegia in adult patients. Each trial was blindly assessed and abstracted by 2 reviewers. The primary outcomes were: low output syndrome(LOS),myocardial infarction(MI), and death. Surrogate outcomes included postoperative creatinine kinase MB(CKMB) increase. Random effects summary odds ratio(OR) for binary outcomes, and weighted mean difference for continuous outcomes were calculated. A total of 34 trials were included. The majority of trials were conducted in patients undergoing elective CABG surgery(n=18). The incidence of LOS was decreased significantly with blood cardioplegia(OR, 0.54; 95%confidence interval[CI], 0.34 to 0.84; P=0.006; 879 patients, 10 trials). The incidence of MI and death were similar between treatment groups(MI: OR, 0.78; 95%CI, 0.54 to 1.13; 4316 patients, 23 trials)(death: OR, 0.80; 95%CI, 0.46 to 1.40; 4022 patients, 17 trials). CKMB release after surgery at 24 hours was reduced with blood cardioplegia(5.9 U/L; 95%CI, 1.6 to 10.2; P=0.007; 821 patients, 7 trials). CONCLUSIONS -Blood cardioplegia provides superior myocardial protection as compared with crystalloid cardioplegia, including lower rates of LOS, and early CKMB increase, whereas the incidence of myocardial infarction and death are similar.
