摘要
目的通过检索临床随机对照(RCT)文章进行Meta分析,比较常温体外循环与低温体外循环,以期寻找常温体外循环的优势与缺点。方法检索Pubmed,Embase和Cochrane图书馆,检索时间截止至2013年9月28日。符合要求的文章为,随机将成人心脏手术患者分配至常温体外循环组与低温体外循环组的英文文章。使用随机效应模型,计算相对危险度(RR)及95%可信区间来评价二分类变量,计算加权均数差(WMD)或标准均数差(SMD)及其相应的95%可信区间来评价连续性变量。I2检验来评价异质性。当不存在异质性时(即I2=0)使用固定效应模型。主要的临床终点为全因死亡率及脑血管意外。结果初查结果 3 910篇文章,最终纳入文献为27篇,9 298例患者。全因死亡率,常温组降低,且有统计学意义(RR0.66,95%CI 0.49-0.90;P=0.009;I2=0)。常温组脑血管意外发生率升高,结果有统计学意义(RR 1.83,95%CI 1.21-2.77;P=0.004;I2=0)。结论常温体外循环技术成人体外循环的全因死亡率低,但是脑血管意外发生率会增高。常温体外循环技术可以适用于一些成人心脏手术,但同时脑保护显得更加重要。
Objective The controversy over the benefits between normothermia and hypothermia in cardiopulmonary bypass（CPB） is still uncertain. The purpose of this systematic review and meta-analysis is to investigate the benefits and risks of normother-mia compared with hypothermia in patients who underwent CPB in randomized controlled trials（ RCTs）.Methods We searchedPubmed, Embase, and the Cochrane Central Register of Controlled Trialsup to September 28, 2013 for studies reported in English. Eli-gible studies were those in which investigators enrolled adult patients who had cardiac surgery and randomised them to normothermic orhypothermic CPB. We prespecified the use of random-effects models to calculate risk ratios（RR） and 95% CIs for binary variables,weighted mean difference（WMD） or standard mean difference（SMD） and 95% CIs for continuous variables. We assessed heterogene-ity using I2. When heterogeneity was absent（I2= 0%）, we used fixed-effects models. The primary outcome was all-cause mortalityand cerebrovascular accident（CVA） in patients who had cardiac surgery in normothermic CPB compared with those in hypothermicCPB.Results The initial search strategy identified 3910 citations, of which 27 trials were eligible. These 27 trials included 9298 par-ticipants. Individuals allocated to normothermic CPB had lower all-cause mortality than those allocated to hypothermic CPB（RR 0.66,95% CI 0.49 – 0.90;P = 0.009; I2= 0%; 7965 patients, 19 trials）. But individuals allocated to normothermic CPB had higher CVAthan those allocated to hypothermic CPB（RR 1.83, 95% CI 1.21-2.77;P = 0.004; I2= 0%; 4182 patients,12 trails）.Conclusion Patients in normothermic CPB has lower mortality but higher CVA compared with those in hypothermic CPB.
出处
《中国体外循环杂志》
2015年第4期209-212,226,共5页
Chinese Journal of Extracorporeal Circulation
基金
国家自然科学基金青年科学基金项目(81300084)
关键词
体外循环
常温
低温
Cardiopulmonary bypass
Normothermia
Hypothermia
