摘要
目的系统评价糖皮质激素预防心脏手术后心房颤动的效果及对患者住院时间的影响。方法全面检索、收集已公开发表的有关比较糖皮质激素和安慰剂预防心脏手术后心房颤动发生的随机对照临床研究,对检索到的原始研究按Meta分析的要求进行严格的质量评估,采用RevMan4.2软件对纳入的研究结果行Meta分析。结果 12篇文献符合纳入标准,总样本量为1 330例。其中糖皮质激素组679例,171例术后发生心房颤动,安慰剂组651例,238例术后发生心房颤动。对心房颤动发生及住院时间分别采用固定效应模型(不存在统计学异质性,I2=0%,P>0.05)和随机效应模型(存在统计学异质性,I2=82.6%,P<0.01)进行合并分析,发现应用糖皮质激素使术后心房颤动的发生率减少31%[相对危险度(RR)=0.69,95%可信区间(95%CI)=0.58~0.81],患者住院时间缩短约1.4天[加权均数差(WMD)=-1.36,95%CI=-2.56^-0.16]。亚组分析显示,糖皮质激素中等剂量组比小剂量组、大剂量组更利于预防心房颤动的发生。敏感性分析证实了Meta分析结果的真实稳定性。结论与安慰剂相比较,糖皮质激素可以降低心脏手术后心房颤动的发生率并缩短患者住院时间。
Objective To conduct a systematic review of the effects of prophylactic glucocorticoid on the incidence of post-cardiothoracic surgery atrial fibrillation and length of stay.Methods We searched and adopted RCTs studies comparing patients receiving glucocorticoid or placebo and reporting data on post-cardiothoracic surgery atrial fibrillation.With the assistance of RevMan 4.2 software,a Meta-analysis was conducted on the outcomes of the included trials after strict evaluation.Results 12 citations met the inclusion criteria,representing 1 330 patients.The cumulative cases in glucocorticoid group were 679 cases,in which 171 cases were diagnosed post-cardiothoracic atrial fibrillation,while in placebo group the cases were 651 and 238 respectively.No significant heterogeneity（I2=0%,P0.05） was found in post-cardiothoracic surgery atrial fibrillatioin and significant heterogeneity in length of stay（I2=82.6%,P0.01） when the data were pooled,so a fixed effect model and a random effect model were used for Meta-analysis respectively.Compared with placebo or no use of glucocorticoid,glucocorticoid lowered patients＇ odds of developing post-cardiothoracic surgery atrial fibrillatioin by 31%（RR=0.69,95%CI=0.58-0.81）,and reduced hospital length of stay by approximately 1.4 days（WMD=-1.36,95%CI=-2.56 to-0.16）.Sub-study analysis displayed that intermediate doses of glucocorticoid had greater reductions in the incidence of post-cardiothotacic than both lower and higher doses.Sensitivity analysis showed that the result was stable.Conclusion Glucocorticoid should be considered for the prevention of atrial fibrillation in high-risk undergoing cardiac surgery and reduction of hospital length of stay.
出处
《临床荟萃》
CAS
2011年第6期473-478,共6页
Clinical Focus
