心脏术后病人重返重症监护病房危险因素的Meta分析

Risk factors for patients returning to intensive care unit after cardiac surgery:a Meta analysis

目的:系统评价心脏术后病人重返重症监护病房的危险因素。方法:通过对PubMed、the Cochrane Library、EMbase、中国知网、万方、维普等数据库中的文献进行检索,由2名研究者严格按照纳入与排除标准独立进行文献筛选、资料提取并评价纳入研究的偏倚风险后,应用RevMan 5.3软件进行Meta分析。结果:共纳入11项研究,心脏术后病人重返监护室率为2.8%~7.3%;高龄[OR=1.04,95%CI(1.01,1.07),P=0.01]、非选择性手术[OR=1.68,95%CI(1.23,2.28),P=0.001]、多瓣膜置换[OR=3.80,95%CI(1.72,8.40),P=0.001]、单瓣膜修复或置换+非冠状动脉旁路移植术(CABG)手术[OR=1.43,95%CI(1.09,1.87),P=0.01]、左室射血分数20%~34%[OR=2.06,95%CI(1.07,3.93),P=0.03]、左室射血分数<20%[OR=3.48,95%CI(1.67,7.26),P=0.0009]、心功能分级Ⅲ级、Ⅳ级[OR=1.99,95%CI(1.42,2.78),P<0.0001]、心脏骤停[OR=4.06,95%CI(2.91,5.68),P<0.00001],肺部感染[OR=4.69,95%CI(2.64,8.35),P<0.00001]、胸骨深部感染[OR=7.06,95%CI(4.58,10.87),P<0.00001]、肺炎[OR=3.28,95%CI(2.61,4.12),P<0.00001]、术后肾衰竭[OR=12.88,95%CI(5.15,32.24),P<0.00001]、胃肠道出血[OR=4.48,95%CI(2.85,7.03),P<0.00001]、术后中枢神经功能紊乱[OR=2.41,95%CI(1.63,3.57),P<0.0001]、CABG术后病人Euro Score评分高[OR=22.35,95%CI(6.22,80.35),P<0.00001]、心脏术后病人Euro Score评分高[OR=1.02,95%CI(1.01,1.03),P<0.00001]均是心脏术后病人重返监护室的危险因素。结论:现有证据表明,高龄、多瓣膜置换、单瓣膜修复或置换+非CABG手术、心脏骤停、术后中枢神经系统功能紊乱、既往肺部感染、肺炎、胸骨深部感染、胃肠道出血、肾衰竭、术后肾衰竭、心脏射血分数低、Euro Score评分低是其重要危险因素。

Objective:To systematically review the risk factors for patients returning to ICU after cardiac surgery.Methods:Literature were searched from PubMed,the Cochrane Library,EMbase,CNKI,WanFang Data,VIP and other databases.Two researchers independently conducted literature screening,data extraction and evaluated the risk of bias in the included study in strict accordance with the inclusion and exclusion criteria,and then Meta-analysis was performed with RevMan 5.3 software.Results:A total of 11 studies were included.The rate of patients returning to the ICU after cardiac surgery was 2.8%~7.3%.Elderly[OR=1.04,95%CI(1.01,1.07),P=0.01],non selective surgery[OR=1.68,95%CI(1.23,2.28),P=0.001],multi valve replacement[OR=3.80,95%CI(1.72,8.40),P=0.001],single valve membrane repair or replacement+non CABG surgery[OR=1.43,95%CI(1.09,1.87),P=0.01],left ventricular ejection fraction 20%~34%[OR=2.06,95%CI(1.07,3.93),P=0.03],left ventricular ejection fraction<20%[OR=3.48,95%CI(1.67,7.26),P=0.0009],grade 3 and 4 cardiac function[OR=1.99,95%CI(1.42,2.78),P<0.0001],cardiac arrest[OR=4.06,95%CI(2.91,5.68),P<0.00001],pulmonary infection[OR=4.69,95%CI(2.64,8.35),P<0.00001],deep sternal infection[OR=7.06,95%CI(4.58,10.87),P<0.00001],pneumonia[OR=3.28,95%CI(2.61,4.12),P<0.00001],postoperative renal failure[OR=12.88,95%CI(5.15,32.24),P<0.00001],gastrointestinal bleeding[OR=4.48,95%CI(2.85,7.03),P<0.00001],postoperative central nervous system dysfunction[OR=2.41,95%CI(1.63,3.57),P<0.0001],Euro score of patients after CABG[OR=2.41,95%CI(1.63,3.57),P<0.00001],and lower Euro Score of patients after cardiac surgery lower[OR=1.02,95%CI(1.01,1.03),P<0.00001]were all risk factors for patients returning to the intensive care unit after cardiac surgery.Conclusion:Current evidences shows that the elderly,multi valve replacement,single valve membrane repair or replacement+non CABG surgery,cardiac arrest,postoperative central nervous system dysfunction,previous pulmonary infection,pneumonia,deep sternal infection,gastrointestinal bleeding,renal failure,postoperative renal failure,low cardiac ejection fraction and low Euro Score are important risk factors.