心脏停搏液灌注方式与术后心功能关系的Meta分析
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摘要
目的:探讨停跳心脏手术中,顺灌与联合灌注心脏停搏液在不同心脏疾病与手术应用中的优劣,为指导临床个体化选择停搏液灌注方式,取得最佳心肌保护效果提供高等级循证医学证据。方法:计算机检索1992-2015年PubMed、Ovid、EMBASE、Highwire、Cochrane图书馆及中国期刊全文数据库(CNKI)与万方数据库等中外文数据库,收集有关比较联合灌注与单纯顺灌心脏停搏液对术后心功能影响的临床随机对照研究。按Cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.1软件进行Meta分析。结果:纳入文献14篇,患者728例。联合灌注组术后恶性心律失常发生率(4项研究,231病例,OR=2.82,95%CI=1.16~6.86,P=0.02)与需要使用正性肌力药物支持的患者比例(7项研究,450病例,OR=2.02,95%CI=1.11~3.68,P=0.02)均低于顺灌组;低心排出量、围术期心肌梗死及30d内死亡率组间差异无统计学意义。冠脉搭桥手术中,联合灌注组主动脉开放后心脏一次性复跳率优于顺灌组(2项研究,79病例,OR=0.05,95%CI=0.01~0.25,P=0.0002)。结论:联合灌注心脏停搏液较单纯顺灌能够减少体外循环下停跳心脏手术中心脏不良事件的发生率,这一区别在冠脉搭桥手术中更为明显。
Objective:To compare cardiac function recovery between antegrade and combined retrograde cardioplegic delivery strategies,and to discovery which strategy is better in different cardiac disease and surgery.Method:Published RCT papers about cardioplegic delivery strategy were searched in Pubmed,OVID,EMBASE,Cochrane library,Highwire,CNKI and Wanfang data since 1992 till now.Cochrane system was used to evaluate the included literature quality,and the RevMan5.1software was used to take Meta analysis.Result:A total of 728 patients from 14 papers was included.There was lower intropic user ratio(7trails,450 patients,OR=2.02,95%CI=1.11-3.68,P=0.02)and severe arrhythmia(4trails,231 patients,OR=2.82,95%CI=1.16-6.86,P=0.02).There was no difference in low output,peri-operative MI and death in 30 days between groups.In CABG subgroup,the ratio of sinus after declamping(2trails,79 patients,OR=0.05,95%CI=0.01-0.25,P=0.0002)was higher in combination group.Conclusion:Comparing to antegrade delivery,combined delivery can reduce adverse cardiac events in cardiac arrest surgery under cardiopulmonary bypass,especially in coronary artery bypass grafting.
Objective:To compare cardiac function recovery between antegrade and combined retrograde cardioplegic delivery strategies,and to discovery which strategy is better in different cardiac disease and surgery.Method:Published RCT papers about cardioplegic delivery strategy were searched in Pubmed,OVID,EMBASE,Cochrane library,Highwire,CNKI and Wanfang data since 1992 till now.Cochrane system was used to evaluate the included literature quality,and the RevMan5.1software was used to take Meta analysis.Result:A total of 728 patients from 14 papers was included.There was lower intropic user ratio(7trails,450 patients,OR=2.02,95%CI=1.11-3.68,P=0.02)and severe arrhythmia(4trails,231 patients,OR=2.82,95%CI=1.16-6.86,P=0.02).There was no difference in low output,peri-operative MI and death in 30 days between groups.In CABG subgroup,the ratio of sinus after declamping(2trails,79 patients,OR=0.05,95%CI=0.01-0.25,P=0.0002)was higher in combination group.Conclusion:Comparing to antegrade delivery,combined delivery can reduce adverse cardiac events in cardiac arrest surgery under cardiopulmonary bypass,especially in coronary artery bypass grafting.
引文
[1]赵赟,胡克俭,程玥,等.顺逆灌结合开放前温血灌技术在双瓣膜置换手术中的应用[J].中国体外循环杂志,2009,7(4):193-195.
[2]RADMEHR H,SOLEIMANI A,TATARI H,et al.Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia?[J].Heart Lung Circ,2008,17:475-477.
[3]ASCIONE R,SULEIMAN S M,ANGELINI G D.Retrograde hot-shot cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement[J].Ann Thorac Surg,2008,85:454-458.
[4]张希,姚尖平,熊迈,等.顺逆行结合灌注冷停搏液对心肌保护的作用[J].中山医科大学学报,2001,22(4):264-266,291.
[5]DAGENAIS F,PELLETIER L C,CARRIER M.Antegrade/retrograde cardioplegia for valve replacement:aprospective study[J].Ann Thorac Surg,1999,68:1681-1685.
[6]KAUKORANTA P K,LEPOJRVI M V,KIVILUOMA K T,et al.Myocardial protection during antegrade versus retrograde cardioplegia[J].Ann Thorac Surg,1998,66:755-761.
[7]TAREK A A,NAJIB A K,MOHAMED A A,et al.Antegrade-retrograde cardioplegia for myocardial protection during coronary artery bypass graft surgery[J].Asian Cardiovasc Thorac Ann,1998,6:188-194.
[8]HONKONEN E L,KAUKINEN L,PEHKONEN E J,et al.Combined antegrade-retrograde blood cardioplegia does not protect right ventricle better than either technique alone in patients with occluded right coronary artery[J].Scand Cardiovasc J,1997,31:289-295.
[9]CHOURAQUI P,RABINOWITZ B,LIVSCHITZ S,et al.Effects of antegrade versus combined antegrade/retrograde cardioplegia on postoperative septal wall motion in patients undergoing open heart surgery[J].Cardiology,1997,88:526-529.
[10]NEUMANN F,MOHL W,GRIESMACHER A,et al.Perioperative myocardial injury with different modes of antegrade and retrograde cardioplegic delivery[J].Eur J Cardiothorac Surg,1996,10:185-193.
[11]CHOCRON S,ALWAN K,TOUBIN G,et al.Crystalloid cardioplegia route of delivery and cardiac troponin I release[J].Ann Thorac Surg,1996,62:481-485.
[12]CERNAIANU A C,FLUM D R,MAURER M,et al.Comparison of antegrade with antegrade/retrograde cold blood cardioplegia for myocardial revascularization[J].Tex Heart Inst J,1996,23:9-14.
[13]JEGADEN O,EKER A,MONTAGNA P,et al.Antegrade/retrograde cardioplegia in arterial bypass grafting:Metabolic randomized clinical trial[J].Ann Thorac Surg,1995,59:456-461.
[14]SAVUNEN T,KUTTILA K,RAJALIN A,et al.Combined cardioplegia delivery offers no advantage over antegrade cardioplegia administration in coronary surgical patients with a preserved left ventricular function[J].Eur J Cardiothorac Surg,1994,8:640-644.
[15]MENASCHP,KURAL S,FAUCHET M,et al.Retrograde coronary sinus perfusion:a safe alternative for ensuring cardioplegic delivery in aortic valve surgery[J].Ann Thorac Surg,1982,34:647-658.
[16]GURU V,OMURA J,ALGHAMDI A A,et al.Is blood superior to crystalloid cardioplegia?A Meta-analysis of randomized clinical trials[J].Circulation,2006,114:I331-I338.
[17]FAN Y,ZHANG A M,XIAO Y B,et al.Warm versus cold cardioplegia for heart surgery:a Meta-analysis[J].Eur J Cardiothorac Surg,2010,37:912-919.
[18]ONORATI F,DE FEO M,MASTROROBERTO P,et al.Unstable angina and non-ST segment elevation:surgical revascularization with different strategies[J].Eur J Cardiothorac Surg,2005,27:1043-1050.
[2]RADMEHR H,SOLEIMANI A,TATARI H,et al.Does combined antegrade-retrograde cardioplegia have any superiority over antegrade cardioplegia?[J].Heart Lung Circ,2008,17:475-477.
[3]ASCIONE R,SULEIMAN S M,ANGELINI G D.Retrograde hot-shot cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement[J].Ann Thorac Surg,2008,85:454-458.
[4]张希,姚尖平,熊迈,等.顺逆行结合灌注冷停搏液对心肌保护的作用[J].中山医科大学学报,2001,22(4):264-266,291.
[5]DAGENAIS F,PELLETIER L C,CARRIER M.Antegrade/retrograde cardioplegia for valve replacement:aprospective study[J].Ann Thorac Surg,1999,68:1681-1685.
[6]KAUKORANTA P K,LEPOJRVI M V,KIVILUOMA K T,et al.Myocardial protection during antegrade versus retrograde cardioplegia[J].Ann Thorac Surg,1998,66:755-761.
[7]TAREK A A,NAJIB A K,MOHAMED A A,et al.Antegrade-retrograde cardioplegia for myocardial protection during coronary artery bypass graft surgery[J].Asian Cardiovasc Thorac Ann,1998,6:188-194.
[8]HONKONEN E L,KAUKINEN L,PEHKONEN E J,et al.Combined antegrade-retrograde blood cardioplegia does not protect right ventricle better than either technique alone in patients with occluded right coronary artery[J].Scand Cardiovasc J,1997,31:289-295.
[9]CHOURAQUI P,RABINOWITZ B,LIVSCHITZ S,et al.Effects of antegrade versus combined antegrade/retrograde cardioplegia on postoperative septal wall motion in patients undergoing open heart surgery[J].Cardiology,1997,88:526-529.
[10]NEUMANN F,MOHL W,GRIESMACHER A,et al.Perioperative myocardial injury with different modes of antegrade and retrograde cardioplegic delivery[J].Eur J Cardiothorac Surg,1996,10:185-193.
[11]CHOCRON S,ALWAN K,TOUBIN G,et al.Crystalloid cardioplegia route of delivery and cardiac troponin I release[J].Ann Thorac Surg,1996,62:481-485.
[12]CERNAIANU A C,FLUM D R,MAURER M,et al.Comparison of antegrade with antegrade/retrograde cold blood cardioplegia for myocardial revascularization[J].Tex Heart Inst J,1996,23:9-14.
[13]JEGADEN O,EKER A,MONTAGNA P,et al.Antegrade/retrograde cardioplegia in arterial bypass grafting:Metabolic randomized clinical trial[J].Ann Thorac Surg,1995,59:456-461.
[14]SAVUNEN T,KUTTILA K,RAJALIN A,et al.Combined cardioplegia delivery offers no advantage over antegrade cardioplegia administration in coronary surgical patients with a preserved left ventricular function[J].Eur J Cardiothorac Surg,1994,8:640-644.
[15]MENASCHP,KURAL S,FAUCHET M,et al.Retrograde coronary sinus perfusion:a safe alternative for ensuring cardioplegic delivery in aortic valve surgery[J].Ann Thorac Surg,1982,34:647-658.
[16]GURU V,OMURA J,ALGHAMDI A A,et al.Is blood superior to crystalloid cardioplegia?A Meta-analysis of randomized clinical trials[J].Circulation,2006,114:I331-I338.
[17]FAN Y,ZHANG A M,XIAO Y B,et al.Warm versus cold cardioplegia for heart surgery:a Meta-analysis[J].Eur J Cardiothorac Surg,2010,37:912-919.
[18]ONORATI F,DE FEO M,MASTROROBERTO P,et al.Unstable angina and non-ST segment elevation:surgical revascularization with different strategies[J].Eur J Cardiothorac Surg,2005,27:1043-1050.