远端缺血预处理对肝癌肝切除术患者预后影响的Meta分析

Effect of remote ischemic preconditioning on clinical prognosis of liver cancer patients undergoing hepatectomy:a Meta-analysis

目的系统评价远端缺血预处理(RIPC)对肝癌肝切除术患者预后的影响。方法计算机检索PubMed、Medline、Embase、Cochrane Library(CENTRAL)、CBM、CNKI、维普和万方等数据库,搜集关于RIPC对肝切除术患者预后影响的随机对照试验(RCT),检索时间段为建库至2020年3月。英文检索词主要包括:hepatectomy、liver resection、remote ischemic preconditioning、limb ischemic preconditioning、randomized control trial。中文检索词主要包括:肝切除术、肝切除手术、肝脏手术、远程缺血预处理、远端缺血预处理、肢体缺血预处理、随机对照试验。根据纳入、排除标准查找相关文献,提取数据后采用RevMan 5.3及STATA 14.0软件进行Meta分析。结果最终纳入7项RCT研究,共395例患者。结果显示,RIPC组术中输血量明显低于对照组(SMD=-0.39,95%CI:-0.62~-0.15;P<0.05)。RIPC组术后第1天AST、ALT水平均低于对照组(SMD=-1.65,-1.87;95%CI:-2.74~-0.57,-3.03~-0.72;P<0.05)。结论RIPC有益于肝癌肝切除术患者术后早期肝功能恢复。

Objective To systematically evaluate the effect of remote ischemic preconditioning(RIPC)on the clinical prognosis of patients with liver cancer undergoing hepatectomy.Methods Randomized controlled trials(RCT)evaluating the effect of RIPC on clinical prognosis of patients undergoing hepatectomy from the inception until March,2020 were retrieved from PubMed,MEDLINE,Embase,Cochrane Library(CENTRAL),CBM,CNKI,Chongqing VIP and Wanfang databases.The search terms were hepatectomy,liver resection,remote ischemic preconditioning,limb ischemic preconditioning and randomized control trial in both English and Chinese.Literature were included according to the inclusion and exclusion criteria.Relevant data were extracted and subjected to Meta-analysis with RevMan 5.3 and STATA 14.0 software.Results 7 RCTs consisting of 395 cases were eventually included.In RIPC group,the volume of intraoperative blood transfusion was significantly lower than that in control group(SMD=-0.39,95%CI:-0.62 to-0.15;P<0.05).In RIPC group,the levels of AST and ALT at postoperative 1 d were significantly lower compared with those in control group(SMD=-1.65,-1.87;95%CI:-2.74 to-0.57,-3.03 to-0.72;P<0.05).Conclusion RIPC contributes to the early recovery of liver function after hepatectomy in liver cancer patients.