单侧与双侧顺行性脑灌注技术对主动脉手术患者预后影响的系统评价与Meta分析

Unilateral versus bilateral antegrade selective cerebral perfusion technique in aortic surgery:A systematic review and meta-analysis

目的比较单侧与双侧顺行性脑灌注技术对主动脉手术患者预后的影响。方法检索PubMed、EBSCO、Web of Science、Cochrane图书馆、万方数据库、中国知网、中国生物医学文献数据库,检索时间从建库截至2019年1月。纳入比较单侧与双侧顺行脑灌注技术对主动脉手术患者预后影响的临床研究,用纽卡斯尔-渥太华量表(NOS)评价纳入非随机研究质量,用Cochrane风险评估工具评价随机对照研究的质量。应用RevMan5.3软件进行Meta分析。结果最终纳入16篇文献,共4490例患者,其中随机对照研究3篇,倾向性匹配分析2篇,回顾性病例对照研究11篇。3篇随机对照研究均有高风险偏倚,其余13篇NOS评分均6颗星以上。Meta分析结果显示,单侧与双侧顺行性脑灌注相比,永久性神经系统障碍(permanent neurologic dysfunction,PND)(OR=0.93,95%CI 0.74~1.18,P=0.57)、暂时性神经系统障碍(temporary neurologic dysfunction,TND)(OR=1.26,95%CI 0.94~1.69,P=0.12)、急性肾功能损伤发生率(OR=1.11,95%CI 0.79~1.55,P=0.55)、30 d死亡率(OR=0.94,95%CI 0.67~1.32,P=0.72)、住ICU时间(OR=–0.64,95%CI–1.66~0.37,P=0.22)与住院时间(OR=–0.35,95%CI–2.38~1.68,P=0.74)差异均无统计学意义。结论单侧与双侧顺行性脑灌注技术在停循环主动脉手术中对患者术后预后影响无差别。但上述结论受纳入文献质量的限制,需要更多高质量的随机对照大样本研究进一步评价。

Objective To investigate the clinical efficacy of unilateral antegrade selective cerebral perfusion(UASCP)compared to bilateral antegrade selective cerebral perfusion(BASCP)in aortic surgery.Methods PubMed,EBSCO,Web of Science,Cochrane Library,CBM,CNKI,Wanfang Database were searched from establishment of each database to January 2019 to identify clinical studies on prognosis of UASCP versus BASCP in aortic surgery patients.The quality of randomized controlled trials was assessed by Cochrane risk assessement tool.The quality of non-randomized controlled trials was assessed by the Newcastle-Ottawa Scale(NOS).Meta-analyses were presented in terms of odds ratio(OR)with 95%confidence interval(CI)by using RevMan 5.3 software.Results Sixteen eligible studies including 3 randomized controlled trials,2 propensity matching score studies,and 11 retrospective case control studies including4490 patients were identified.The 3 randomized controlled trials were with high bias risk.The NOS score of the other13 studies was more than 6 stars.Pooled analysis showed no significant difference between the UASCP and BASCP groups in terms of permanent neurological dysfunction(PND)(OR=0.93,95%CI 0.74 to 1.18,P=0.57),temporary neurological dysfunction(TND)(OR=1.26,95%CI 0.94 to 1.69,P=0.12),acute kidney injury rate(OR=1.11,95%CI 0.79 to 1.55,P=0.55),30-day mortality(OR=0.94,95%CI 0.67 to 1.32,P=0.72),length of ICU stay(OR=–0.64,95%CI–1.66 to 0.37,P=0.22)and hospital stay(OR=–0.35,95%CI–2.38 to 1.68,P=0.74).Conclusion This meta-analysis shows that UASCP and BASCP administration do not result in different mortality and neurologic morbidity rates.However,more studies with good methodologic quality and large sample are still needed to make further assessment.