非体外循环冠状动脉旁路移植术前不停用阿司匹林安全性的Meta分析

Safety of preoperative aspirin use in patients undergoing off-pump coronary artery bypass grafting:a meta-analysis

目的系统性评价非体外循环冠状动脉旁路移植(OPCABG)术前不停用阿司匹林的安全性。方法计算机检索Pubmed、Web of Science、COCHRANE LIBRARY、CNKI和万方等数据库检索建库至2016年5月的相关文献;严格按照纳入标准筛选文献、提取资料,应用Review Manager 5.2软件进行Meta分析。结果共纳入1项随机对照研究和5项回顾性研究,包括4 368例患者。术前不停用阿司匹林(CA)组与术前停用阿司匹林(DA)组术后24h胸液量(均数差=32.83,95%CI:-7.92□73.58,P=0.11)、总胸液量(均数差=19.07,95%CI:-30.86□69.01,P=0.45)、输红细胞量(均数差=0.18,95%CI:-0.15□0.50,P=0.28)、输血浆量(均数差=-3.30,95%CI:-44.84□38.24,P=0.88)、术后呼吸机应用时间(均数差=-0.07,95%CI:-0.86□0.71,P=0.85)、二次开胸次数(OR=1.04,95%CI:0.52□2.08,P=0.91)比较,差异均无统计学意义。结论 OPCABG前不停用阿司匹林并不影响手术安全性。

Objective To systematically assess the safety of preoperative aspirin use in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods Databases including Pubmed, Web of Science, COCHRANE LIBRARY,WanFang Data and CNKI Data were searched from inception to May 2016 for clinical studies for OPCABG without stopping pre-operative aspirin use. According to the inclusion criterion, relevant articles were screened. The data were extracted, thequality was assessed, and meta-analysis was performed using Rev Man 5.2. Results One randomized controlled trial (RCT)and 5 retrospective studies involving 4368 patients were included. The result of meta-analyses showed that there were nosignificant differences in volume of 24-h drainage(MD=32.83, 95%CI: -7.92~73.58, P=0.11), volume of total drainage(MD=19.07, 95%CI:-30.86~69.01, P=0.45), volume of transfusion red blood cells (MD=0.18, 95%CI: -0.15~0.50, P=0.28), volumeof transfusion of fresh frozen plasma(MD=-3.30, 95%CI: -44.84~38.24, P=0.88), ventilation time(MD=-0.07, 95%CI: -0.86~0.71,P=0.85), reoperation due to bleeding (OR=1.04, 95%CI: 0.52~2.08, P=0.91) between discontinued aspirin group and continued aspirin group. Conclusion Current evidence indicates that preoperative continuation of aspirin therapy dose not increase bleeding related complications, or extend ventilation time in patients with OPCABG.