急性A型主动脉夹层术后发生低氧血症危险因素的Meta分析

Risk factors for hypoxemia after acute Type A aortic dissection: A meta-analysis

目的 分析急性A型主动脉夹层术后发生低氧血症的危险因素。方法 计算机检索中国知网、万方数据、中文科技期刊数据库、维普数据库、Pubmed、Web of science、Cochrane Library以及Embase数据库。检索时间为建库至2022年4月15日,由两位评价人员按照纳入与排除标准分别独立筛选文献,提取资料以及相关文献质量评价。采用卡斯尔-渥太华量表(NOS)评价纳入研究的质量。采用RevMan 5.4软件对收集的资料进行Meta分析。结果 最终纳入6篇文献,均为回顾性病例对照研究,共788例患者,NOS量表评价纳入文献质量均为6分及以上。A型主动脉夹层术后发生低氧血症共333例,术后未发生低氧血症共455例,最终Meta结果显示,BMI≥25 kg/m^(2)[OR=3.47, 95%CI:2.00~6.07 P<0.001],术前PaO_(2)/FiO_(2)≤300[OR=3.21, 95%CI:1.81~5.66, P<0.001],深低温停循环时间[OR=4.87, 95%CI:2.97~6.76 P<0.001],术中及术后输血量[OR=3.23, 95%CI:2.56~3.90, P<0.001]合并效应量具有统计学意义,为A型主动脉夹层术后发生低氧血症的危险因素。结论 Meta分析研究表明,BMI≥25 kg/m^(2),术前PaO_(2)/FiO_(2)≤300,深低温停循环时间以及术中及术后输血量为急性A型主动脉夹层术后发生低氧血症的危险因素。术后低氧血症是急性A型主动脉夹层患者术后的常见并发症,严重影响患者术后的转归,临床医生应更加注意此类患者围手术期的管理,尽可能的降低患者术后低氧血症的发生,提高患者生存率及预后生活质量。

Objective To identify the risk factors of hypoxemia after acute type A aortic dissection. Methods Databases including CNKI, WANFANG, CBM, VIP, PubMed, Web of Science, Cochrane Library, and Embase were used for searching articles published before April 15, 2022. Two evaluators independently screened literature, extracted data, and evaluated the quality of relevant articles according to the inclusion and exclusion criteria. The Castle-Ottawa Scale(NOS) was used to evaluate the quality of the included studies. RevMan 5.4 software was used for meta-analysis of the collected data. Results Finally, six pieces of literature were selected according to the inclusion and exclusion criteria. All of the six studies had a retrospective case-control design and a total of 788 patients. The quality of the included literature was 6 points or above on NOS scale evaluation. A total of 333 patients developed hypoxemia after type A aortic dissection, while 455 patients did not. Final meta-analysis results showed that the combination effect of body mass index(BMI) ≥25 kg/m^(2)(odds ratio [OR] =3.47, 95% confidence interval [CI]: 2.00-6.07, P<0.001), preoperative PaO_(2)/FiO_(2) ≤300(OR=3.21, 95%CI: 1.81-5.66, P<0.001), cryogenic stop cycle time(OR=4.87, 95%CI: 2.97-6.76) P<0.001),intraoperative and postoperative blood transfusion volume(OR=3.23, 95%CI: 2.56-3.90, P<0.001) was statistically significant, and these were risk factors for hypoxemia after type A aortic dissection. Conclusions Meta-analysis shows that BMI ≥25 kg/m^(2), preoperative PaO_(2)/FiO_(2) ≤300, deep hypothermia circulation stop time, and intraoperative and postoperative blood transfusion volumes are risk factors for hypoxemia after acute type A aortic dissection. Postoperative hypoxemia is a common postoperative complication in patients with acute type A aortic dissection, which seriously affects the postoperative outcomes. Clinicians should pay more attention to the perioperative management of such patients, for reducing the incidence of postoperative hypoxemia as much as possible, and improving the quality of life of patients,thereby also improving the survival rate and prognosis.