摘要
目的尽管迷你体外循环（MECC）技术住欧洲的临床使用已经超过十年，与常规体外循环相比其在临床上的优势仍仔在一定争议，就此问题我们针对过往的相关文献进行了大规模的系统评价和荟萃分析。探讨其在临床中的应用价值和在未来体外循环中应用的前最。方法我们对PubMed，EMBASE和CochraneLibrary数据库进行了相关文献的检索。使用Stata12．0软件进行了合并效应量的计算，并通过敏感性分析和meta回归进行了异质性来源的分析。进行累计性分析，观察合并效应量随时间的变化；观察漏斗图，并对研究进行Begg’s和Egger’s检验，以评估文献是否仔在发表偏倚。结果通过数据库检索共纳入41项研究，共计3202名进行心脏手术的成年患者．MECC可以显著降低输血牢（RR，0．5；95％CI，0．30．84；P=0．009；12=68．6％），房颤率（RR，0．7I；95％CI，0．580．86；P=O．001；12=0％），和心梗率（RR，0．458；95％CI．0．260．806；P=0．007；12=0％）。此外，MECC组的出血量、新鲜冰冻血浆输注量、血小板计数、红细胞输注量、ICU时间和肌钙蛋白T均娃著低于常规体外循环组。Meta回归分析的结果显示，在术区左窒射血分数较低或有较高欧洲心脏手术风险评分的患者中，MECC的优势更为明显。结论MECC可以保护血液，减少血制品的输入，并能降低术后心血管并发症的发生。Mela回归分析的结果提示我们术前状况较差的患者，MECC降低输血率的优势更为明显。
Objective The benefits of minimized extracorporeal circulation （MECC） compared with conventional extracorporeal circulation （CECC） are still in debate. We performed a system review and meta-analysis to evaluate the evidence of protective effects owed to MECC. Methods We searched PubMed, EMBASE and Cochrane Library for relevant studies. Stata 12.0 was used to analysis-pooled results, heterogeneity searching and cumulative analysis for changes during time. To evaluate publication bias, visual observation of funnel plot, Egger＇s test and Begg＇s test were performed. Results 41 randomized controlled trials （RCTs） comparing MECC and CECC were retrieved from database searching, enrolling 3202 adult patients undergoing cardiac surgery. MECC significantly reduced transfusion rate （RR, 0.5; 95%CI, 0.3 to 0.84; P=0.009; 12=68.6%）, atrial fibrillation ）RR, 0.71; 95%CI, 0.58 to 0.86; P=0.001; 12=0%）, and myocardial infarction （RR, 0.458; 95%CI, 0.26 to 0.806; P=0.007; 12=0%）. In addition, bleeding volume, fresh frozen plasma （FFP） transfusion volume, platelet count, red blood cell transfusion volume, ICU time, and cardiac troponin T （cTnT） were also reduced in MECC group. After meta-regression analysis, we found the trend that for patients with lower left ventricular ejection fraction （LVEF）, the benefit of MECC for transfusion rate was more outstanding. Conclusion MECC did conserve blood cells, and reduce transfusion of blood production. It also reduced cardiovascular complications postoperatively. The results from meta-regression analysis showed that for patients in a more critical state, those patients who used MECC showed lower transfusion rate.
出处
《中国分子心脏病学杂志》
CAS
2013年第4期606-613,共8页
Molecular Cardiology of China
关键词
迷你体外循环
保护
体外循环
荟萃分析
Minimized Extracorporeal Circulation
Protection
Cardiopulmonary Bypass
Meta-Analysis
