摘要
目的系统评价Stanford A型主动脉夹层(Stanford type A aortic dissection,TAAD)外科术后低氧血症的危险因素。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方、维普、中国生物医学文献数据库,全面收集国内外TAAD外科术后低氧血症危险因素的相关研究,检索时限为建库至2021年11月。由2名评价者独立筛选文献、提取资料后,进行质量评价,并采用RevMan 5.3软件进行Meta分析。结果共纳入19项回顾性病例对照研究,包含2686例患者,其中低氧血症组1085例。16项研究纽卡斯尔-渥太华量表评分≥7分。共纳入21个独立危险因素,TAAD外科术后低氧血症的发生率为17.12%~68.75%。Meta分析结果显示,年龄[OR=1.10,95%CI(1.06,1.14),P<0.00001]、体重指数[OR=1.87,95%CI(1.49,2.34),P<0.00001]、术前氧合指数≤300 mm Hg[OR=7.13,95%CI(3.48,14.61),P<0.00001]、术前白细胞计数[OR=1.34,95%CI(1.18,1.53),P<0.0001]、深低温停循环时间[OR=1.33,95%CI(1.14,1.57),P=0.0004]、围术期输血[OR=1.89,95%CI(1.49,2.41),P<0.00001]、体外循环时间[OR=1.02,95%CI(1.00,1.03),P=0.02]是术后低氧血症的独立危险因素。术前肌酐、术前肌红蛋白、术前谷丙转氨酶与术后低氧血症不相关。结论现有证据表明,年龄、体重指数、术前氧合指数≤300 mm Hg、术前白细胞计数、深低温停循环时间、围术期输血、体外循环时间是TAAD外科术后低氧血症的危险因素,可用于术后低氧血症高危患者的识别,为医务人员制定术后预防性管理策略提供指导,从而降低其发生率,促进患者康复。鉴于纳入研究质量限制,该结论尚需高质量研究进一步证实。
Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection(TAAD)surgery.Methods Electronic databases including PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,Wanfang Data,VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021.Two authors independently assessed the studies'quality,and a meta-analysis was performed by RevMan 5.3 software.Results A total of 19 case-control studies involving 2686 patients and among them 1085 patients suffered hypoxemia,included 21 predictive risk factors.The score of Newcastle-Ottawa scale≥7 points in 16 studies.Meta-analysis showed that:age(OR=1.10,95%CI 1.06 to 1.14,P<0.00001),body mass index(OR=1.87,95%CI 1.49 to 2.34,P<0.00001),preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen(PaO2/FiO2)≤300 mm Hg(OR=7.13,95%CI 3.48 to 14.61,P<0.00001),preoperative white blood cell count(OR=1.34,95%CI 1.18 to 1.53,P<0.0001),deep hypothermic circulatory arrest time(OR=1.33,95%CI 1.14 to 1.57,P=0.0004),perioperative blood transfusion(OR=1.89,95%CI 1.49 to 2.41,P<0.00001),cardiopulmonary bypass time(OR=1.02,95%CI 1.00 to 1.03,P=0.02)were independent risk factors for hypoxemia after TAAD surgery.Preoperative serum creatinine,preoperative myoglobin,preoperative alanine aminotransferase were not associated with postoperative hypoxemia.Conclusion Current evidence shows that age,body mass index,preoperative PaO2/FiO2≤300 mm Hg,preoperative white blood cell count,deep hypothermic circulatory arrest time,perioperative blood transfusion,cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery.These factors can be used to identify high-risk patients,and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia.The results should be validated by higher quality researches.
作者
向玉萍
罗天会
曾玲
戴小容
XIANG Yuping;LUO Tianhui;ZENG Ling;DAI Xiaorong(Department of Intensive Care Unit/School of Nursing of West China,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第10期1483-1489,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
四川省卫生健康科研课题(19PJ084)
四川省护理科研课题计划(H20042)。
