冠状动脉旁路移植术后低氧血症危险因素的Meta分析

Risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting: a meta-analysis

目的系统评价冠状动脉旁路移植术后低氧血症的危险因素。方法计算机检索PubMed、EBCO、Web of Science、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集有关冠状动脉旁路移植术后低氧血症危险因素的病例-对照研究和队列研究,检索时限均为建库至2018年12月。由2名研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,使用RevMan 5.3软件进行Meta分析。结果共纳入20个研究,包括3 926例患者。Meta分析结果显示:年龄[OR=2.94,95%CI(0.81,5.07),P=0.007]、体重指数[OR=1.94,95%CI(0.77,3.12),P=0.001]、吸烟史[OR=2.72,95%CI(1.68,4.42),P<0.000 1]、糖尿病史[OR=1.63,95%CI(1.37,1.93),P<0.000 01]、术前肺部疾病史[OR=4.11,95%CI(1.64,10.28),P=0.003]、合并室壁瘤[OR=1.57,95%CI(1.12,2.21),P=0.01]、左室舒张末期内径[OR=1.28,95%CI(0.12,2.44),P=0.03]、主动脉阻断时间[OR=13.25,95%CI(4.93,21.57),P=0.002]、手术时间[OR=9.33,95%CI(5.36,13.30),P<0.000 01]、搭桥支数[OR=0.19,95%CI(0.02,0.36),P=0.03]、术中输液量[OR=383.46,95%CI(282.16,484.76),P<0.000 01]、术后肺部感染[OR=6.00,95%CI(3.83,9.42),P<0.000 01]均是冠状动脉旁路移植术后低氧血症的危险因素。术前心脏射血分数[OR=-2.60,95%CI(-4.56,-0.64),P=0.009]、术前氧分压[OR=-3.14,95%CI(-4.72,-1.56),P=0.000 1]是术后低氧血症的保护因素。结论当前证据表明,年龄、体重指数、吸烟、糖尿病史、术前肺部疾病史、合并室壁瘤、左室舒张末期内径、主动脉阻断时间、手术时间、搭桥支数、术中输液量是冠状动脉旁路移植术后低氧血症发生的危险因素。受纳入研究的数量和质量的限制,上述结论尚需要更多高质量研究予以验证。

Objectives To systematically review the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Methods PubMed, EBCO, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies and cohort studies on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting from inception to December 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, metaanalysis was performed by using RevMan 5.3 software. Results A total of 20 articles were included, including 3 926 patients. The results of meta-analysis showed that: age(OR=2.94, 95%CI 0.81 to 5.07, P=0.007), body mass index(OR=1.94, 95%CI 0.77 to 3.12, P=0.001), smoking(OR=2.72, 95%CI 1.68 to 4.42, P<0.000 1), diabetes history(OR=1.63,95%CI 1.37 to 1.93, P<0.000 01), preoperative lung diseases(OR=4.11, 95%CI 1.64 to 10.28, P=0.003), complicated ventricular aneurysm(OR=1.57, 95%CI 1.12 to 2.21, P=0.01), left ventricular end-diastolic diameter(OR=1.28, 95%CI0.12 to 2.44, P=0.03), aortic occlusion time(OR=13.25, 95%CI 4.93 to 21.57, P=0.002), operation time(OR=9.33, 95%CI5.36 to 13.30, P<0.000 01), number of bypass branches(OR=0.19, 95%CI 0.02 to 0.36, P=0.03), intraoperative infusion volume(OR=383.46, 95%CI 282.16 to 484.76, P<0.000 01) and postoperative pulmonary infection(OR=6.00, 95%CI 3.83 to 9.42, P<0.000 01) were the risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Preoperative ejection fraction(OR=-2.60, 95%CI-4.56 to-0.64, P=0.009) and preoperative partial oxygen pressure(OR=-3.14, 95%CI-4.72 to-1.56, P=0.000 1) were the protective factors for postoperative hypoxemia.Conclusions Current evidence shows that age, body mass index, smoking, diabetes history, preoperative lung diseases,complicated ventricular aneurysm, left ventricular end-diastolic diameter, aortic occlusion time, operation time, number of bypass branches, intraoperative infusion volume and postoperative pulmonary infection are risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Due to limited quality and quantity of included studies, the above conclusion is required to be assessed by further studies.