心脏不停跳心内直视手术心肌保护的系统评价
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摘要
目的:用Meta分析的方法对国内已发表的有关心脏不停跳心内直视手术的心肌保护进行系统评价。
方法:收集国内已公开发表的有关心脏不停跳心内直视手术临床实验,以检测血清肌钙蛋白Ⅰ(cTn-Ⅰ)为标准,对符合要求的研究进行Meta分析。
结果:共纳入11项研究符合标准,分3类:先天性心脏病(ASD、VSD、PDA、PS)共5项研究、二尖瓣置换术共3项研究、双瓣置换术共3项研究,所有研究均未描述具体的随机方法,分配隐蔽和盲法。以肌钙蛋白Ⅰ(cTn-Ⅰ)为检测标准,对几个时间点比较,发现不停跳组cTn-Ⅰ在术后几个时间点均比对照组低。
结论:现在研究结果显示:浅低温心脏不停跳心内直视手术具有良好的心肌保护效果。
Objective:To carry out a meta-analysis to evaluate the effect on myocardial protective of heart operation with beating heart.
Methods:The analysis the levels of cardiac troponin(cTn-Ⅰ)used data from published trials in comparison with placebo supplemented where necessary by reference to the original trial reports.
Result:Eleven trials were included,having there groups:inborn heart diseases(ASD、VSD、PDA、PS)five trials;Mitral valve replacement there trials;double valve replacement there trials.All included studies were inadequate in reporting randomization,concealment of allocation.Serum levels of cTn-Ⅰwas measured after anesthesia and at several times after aortic declamping or intra-cardiac manipulation finished,cTn-Ⅰlevels in beating heart group were lower than those in control group at several times after aortic declamping or intra-cardiac.
Conclusion:Beating heart with mild hypothermia has better myocardial protection effects in heart operation.
方法:收集国内已公开发表的有关心脏不停跳心内直视手术临床实验,以检测血清肌钙蛋白Ⅰ(cTn-Ⅰ)为标准,对符合要求的研究进行Meta分析。
结果:共纳入11项研究符合标准,分3类:先天性心脏病(ASD、VSD、PDA、PS)共5项研究、二尖瓣置换术共3项研究、双瓣置换术共3项研究,所有研究均未描述具体的随机方法,分配隐蔽和盲法。以肌钙蛋白Ⅰ(cTn-Ⅰ)为检测标准,对几个时间点比较,发现不停跳组cTn-Ⅰ在术后几个时间点均比对照组低。
结论:现在研究结果显示:浅低温心脏不停跳心内直视手术具有良好的心肌保护效果。
Objective:To carry out a meta-analysis to evaluate the effect on myocardial protective of heart operation with beating heart.
Methods:The analysis the levels of cardiac troponin(cTn-Ⅰ)used data from published trials in comparison with placebo supplemented where necessary by reference to the original trial reports.
Result:Eleven trials were included,having there groups:inborn heart diseases(ASD、VSD、PDA、PS)five trials;Mitral valve replacement there trials;double valve replacement there trials.All included studies were inadequate in reporting randomization,concealment of allocation.Serum levels of cTn-Ⅰwas measured after anesthesia and at several times after aortic declamping or intra-cardiac manipulation finished,cTn-Ⅰlevels in beating heart group were lower than those in control group at several times after aortic declamping or intra-cardiac.
Conclusion:Beating heart with mild hypothermia has better myocardial protection effects in heart operation.
引文
[1].Kirklm JW,Conti VR,Blackstone EH.Myocardial Damage in Cardiac surgery.The New England Journal of Medicine July 19,1979:135.
[2].顾瑞华,于昂,王仲伦,张化新.体外循环心脏不停跳心内直视手术.天津医药.1992:2:105-107.
[3].何巍,林辉,陈铭伍,周华富,吴文森,彭青云.心脏跳动中二尖瓣置换术 中华外科杂志.1996:34(11):678.
[4].林辉,何巍,彭青云等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
[5].Menasche P,eynei J,Haeffner-Cavaillon H,et al.Influence of temperature on neutrophic afficking during clinical cardiopulmonary bypass.Circulation,1995,92(suppl):Ⅱ334.
[6].Kamlot A,Bellow SD,Simkhovich BZ,et al.Is warm wetrograde blood cardioplegia better than cold for myocardial protection.Ann Thorac Sury.1997:63(1):98-104.
[7].Ting W,Spotnitz AJ,Mzckenine JW,et al.Protection of the acutely injuried heart deleterious effects of hypothermia.J Sury Res,1994:56(1):108.
[8]Christopher H,Britta UG,Robert H,et al.Analytical performance and clinical application of a new rapid bedside assay for the detection of serum cardiac troponin I[J].Clinical Chemistry,1998,44:1925-1930.
[9]Vermes E,Mesguich M,Houel R,et al.Cardiac troponin I release after open heart surgery:a marker of myocardial protection[J].Ann Thorac Surg,2000,70(6):2087-2090.
[10]Maynard SJ,Menown IB,Adgey AA.Troponin T or troponin I as cardiac markers in ischemic heart disease[J].Heart,2000,83(4):371-373.
[11]Solaro RJ.Troponin I,stunning,hypertrophy and failure of the heart[J]Circ Res,1999,84(1):122-124.
[12]方积乾,陆盈.Meta分析.现代医学统计学[M].北京:人民卫生出 版社,2002,150-209.
[13]张鸣明,李幼平.Cochrane协作网及Cochrane图书馆[M].北京:科学出版社,2002:25-26.
[14]Clarke M,Oxman A D,editors.Cochrane Reviewers' Handbook 4.0[updated July1999];Section 6.In:The Cochrane Library[database on CDRO[M].The Cochrane Collaboration.Oxford:Update Software;2000,issue 1.
[15]方积乾,陆盈.诊断试验的Meta分析:方积乾,陆盈主编.现代医学统计学[M].北京:人民卫生出版社,2002,182-195.
[16]王吉耀.循证医学与临床实践[M].北京:科学出版社,2002:118-121.
[17]Tonelli MR.The limits of evidence based medicine.[]].Respir Care,2001,46(12):1435-1440.
[18]张海洲,薛涛,范全心,等.心脏跳动下手术对心肌保护作的临床研究[J].中国体外循环,2003,1(4):6-8.
[19].何巍,林辉,覃家锦等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究。中华胸心血管外科杂志 2001;17(2).
[20].康敢军 毛志福.心脏不停跳二尖瓣置换术的心肌保护作用.中国胸心血管外科临床杂志 2002,8:9-3.
[21].Deng Y K,Wei F,Li Z L,et alEsmolol protects the myocardium and facilitates direct version in intracardiac operation with a beating heart[J].Circ J,2002,66:715-717.
[22].张海洲,薛涛,范全心,等.心脏跳动下手术对心肌保护作的临床研究[J].中国体外循环,2003,1(4):6-8.
[23].周晓彤,薛涛.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响.江苏医药杂志,2003,9:29-9.
[24].李香伟,林辉.浅低温心脏不停跳心内直视手术194例临床报告.广西医学,2003,12:25-12.
[25].郑宝石,何巍,陈铭伍等.浅低温体外循环心脏跳动中手术血浆心钠素变化的实验研究.广西医科大学学报 2003;20(3).
[26].加伦,田步升.浅低温心脏不停跳心内直视手术临床分析.长治医 学院学报,2004;3(1)-18.
[27].邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换术心肌保护的体视学研究.中国危重病急救医学,2005,9:17-9.
[28].吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,6:28-6(外科版).
1.Kirklm JW,Conti VR,Blackstone EH,Myocardial Damage in Cardiac surgery.The New England Journal of Medicine July 19,1979:135.
2.顾瑞华,于昂,王仲伦,张化新.体外循环心脏不停跳心内直视手术.天津医药.1992:2:105-107.
3.何巍,林辉,陈铭武,周华富,吴文森,彭青云.心脏跳动中二尖瓣置换术 中华外科杂志.1996:34(11):678.
4.林辉,何巍,彭青云等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
5.Menasche P,eynei J,Haeffner-Cavaillon H,et al.Influence of temperature on neutrophic afficking during clinical cardiopulmonary bypass.Circulation,1995,92(suppl):Ⅱ334.
6.Kamlot A,Bellow SD,Simkhovich BZ,et al,Is warm wetrograde blood cardioplegia better than cold for myocardial protection.Ann Thorac Sury.1997:63(i):98-104.
7.Ting W,Spotnitz AJ,Mzckenine JW,et al.Protection of the acutely injuried heart deleterious effects of hypothermia.J Sury Res,1994:56(1):108.
8.何勇,陈龙,杨胜生等.心脏不停搏下实施高危心脏手术六例报告.第二军医大学学报,1999;20(12):1052.
9.Ting W,Spotnitz AJ,Mackenzie JW,et al.Proteciton of the acutely injured heart deleterious effects of hypothermia,J Surg Res,1994;56(1):108.
10.Robeyka IM,Hanan SA,Borges MR,et al.Rapid cooling contrature of the myocardium,the adverse effect of prearrest cardiac hypothermia.J Thorac Cardiovasc Surg,1990;100(2):2.
11.何巍,彭青云,周华富,等.浅低体外循环心脏跳动中的二尖瓣置换术.医学文选,1995;16(2):95.
12.周文富,胡振快,邹玉荣,等.心脏空跳状态下心内手术的麻醉与体外循环管理.中华麻醉学杂志,1996:16(2):599.
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14.何巍,林辉,覃家锦,等.心脏跳动中瓣膜成形术的方法和初步体会.广西医科大学学报,1997:14(3):76.
15.林辉,何巍,郑陈光,等.心脏不停跳法防止换瓣术后低心排血量综合征的研究.中华实验外科杂志,1998;15(1):44.
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18.周文富,邹玉荣,胡振快,等.心内手术体外循环保持心脏空跳状态对心肌保护的效果.临床麻醉学杂志,1997:13(2):88.
19.董念国,张国报,肖诗亮,等.心脏不停跳心内直视手术的心肌保护效果.中华实验外科杂志,1997(增刊):60.
20.黄旭中,张尔永,董力,等.体外循环心脏不停跳心内直视术.华西医学,1994:9(2):220.
21.华永波,殷桂林,张殿堂,等.浅低温体外循环不阻断主动脉心内直视手术的评价.中华实验外科杂志,1997:11(5):381.
22.林辉,蒋宗滨,何巍,等。经冠状静脉窦逆行灌注法在心脏不停跳瓣膜置换术的应用。中华麻醉学杂志,1997;17(6):347.
23.王忠明,张剑平.浅低温心脏不停跳心内直视手术141例.中国胸心血管外科临床杂志,1999,5:6-2.
24.谢晓阳,李朝先,向小勇,廖晓刚,等.浅低温心脏不停跳心内直视手术心肌保护的微观研究.中华实验外科杂志2001,9:18(5)-473.
25.何巍,林辉,覃家锦等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究.中华胸心血管外科杂志,2001;17(2).
26.康敢军,毛志福.心脏不停跳二尖瓣置换术的心肌保护作用.中国胸心血管外科临床杂志,2002,8:9-3.
27.Toshihiro,Wan Y K,Li Z L,et alEsmolol protects the myocardium and facilitates direct version in intracardiac operation with a beating heart[J].Circ J,2002,.66:715-717.
28.张海洲,薛涛,范全心,等.心脏跳动下手术对心肌保护作的临床研究[J].中国体外循环,2003,1(4):6-8.
29.周晓彤,薛涛.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响.江苏医药杂志,2003,9:29-9.
30.李香伟,林辉.浅低温心脏不停跳心内直视手术194例临床报告.广西医学,2003,12:25-12.
31.郑宝石,何巍,陈铭伍等.浅低温体外循环心脏跳动中手术血浆心钠素变化的实验研究.广西医科大学学报,2003;20(3).
32.加伦,田步升.浅低温心脏不停跳心内直视手术临床分析.长治医学院学报,2004;3(1)-18.
33.邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换术心肌保护的体视学研究.中国危重病急救医学,2005,9:17-9.
34.吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,6:28-6(外科版).
35.周华富,何巍,郑宝石等.心脏跳动中巨大心脏二尖瓣置换术远期疗效。广西医科大学学报,2004,10:21(5).
36.李世康,何巍,陈铭伍等.逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bcl-2,Bax的表达.中国胸心血管外科临床杂志,2006,10:13(5).
37.李世康,何巍,陈铭伍等.逆行灌注心脏不停跳手术对心肌细胞凋亡的影响.中华实验外科杂志,2006,12:23(12).
[2].顾瑞华,于昂,王仲伦,张化新.体外循环心脏不停跳心内直视手术.天津医药.1992:2:105-107.
[3].何巍,林辉,陈铭伍,周华富,吴文森,彭青云.心脏跳动中二尖瓣置换术 中华外科杂志.1996:34(11):678.
[4].林辉,何巍,彭青云等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
[5].Menasche P,eynei J,Haeffner-Cavaillon H,et al.Influence of temperature on neutrophic afficking during clinical cardiopulmonary bypass.Circulation,1995,92(suppl):Ⅱ334.
[6].Kamlot A,Bellow SD,Simkhovich BZ,et al.Is warm wetrograde blood cardioplegia better than cold for myocardial protection.Ann Thorac Sury.1997:63(1):98-104.
[7].Ting W,Spotnitz AJ,Mzckenine JW,et al.Protection of the acutely injuried heart deleterious effects of hypothermia.J Sury Res,1994:56(1):108.
[8]Christopher H,Britta UG,Robert H,et al.Analytical performance and clinical application of a new rapid bedside assay for the detection of serum cardiac troponin I[J].Clinical Chemistry,1998,44:1925-1930.
[9]Vermes E,Mesguich M,Houel R,et al.Cardiac troponin I release after open heart surgery:a marker of myocardial protection[J].Ann Thorac Surg,2000,70(6):2087-2090.
[10]Maynard SJ,Menown IB,Adgey AA.Troponin T or troponin I as cardiac markers in ischemic heart disease[J].Heart,2000,83(4):371-373.
[11]Solaro RJ.Troponin I,stunning,hypertrophy and failure of the heart[J]Circ Res,1999,84(1):122-124.
[12]方积乾,陆盈.Meta分析.现代医学统计学[M].北京:人民卫生出 版社,2002,150-209.
[13]张鸣明,李幼平.Cochrane协作网及Cochrane图书馆[M].北京:科学出版社,2002:25-26.
[14]Clarke M,Oxman A D,editors.Cochrane Reviewers' Handbook 4.0[updated July1999];Section 6.In:The Cochrane Library[database on CDRO[M].The Cochrane Collaboration.Oxford:Update Software;2000,issue 1.
[15]方积乾,陆盈.诊断试验的Meta分析:方积乾,陆盈主编.现代医学统计学[M].北京:人民卫生出版社,2002,182-195.
[16]王吉耀.循证医学与临床实践[M].北京:科学出版社,2002:118-121.
[17]Tonelli MR.The limits of evidence based medicine.[]].Respir Care,2001,46(12):1435-1440.
[18]张海洲,薛涛,范全心,等.心脏跳动下手术对心肌保护作的临床研究[J].中国体外循环,2003,1(4):6-8.
[19].何巍,林辉,覃家锦等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究。中华胸心血管外科杂志 2001;17(2).
[20].康敢军 毛志福.心脏不停跳二尖瓣置换术的心肌保护作用.中国胸心血管外科临床杂志 2002,8:9-3.
[21].Deng Y K,Wei F,Li Z L,et alEsmolol protects the myocardium and facilitates direct version in intracardiac operation with a beating heart[J].Circ J,2002,66:715-717.
[22].张海洲,薛涛,范全心,等.心脏跳动下手术对心肌保护作的临床研究[J].中国体外循环,2003,1(4):6-8.
[23].周晓彤,薛涛.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响.江苏医药杂志,2003,9:29-9.
[24].李香伟,林辉.浅低温心脏不停跳心内直视手术194例临床报告.广西医学,2003,12:25-12.
[25].郑宝石,何巍,陈铭伍等.浅低温体外循环心脏跳动中手术血浆心钠素变化的实验研究.广西医科大学学报 2003;20(3).
[26].加伦,田步升.浅低温心脏不停跳心内直视手术临床分析.长治医 学院学报,2004;3(1)-18.
[27].邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换术心肌保护的体视学研究.中国危重病急救医学,2005,9:17-9.
[28].吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,6:28-6(外科版).
1.Kirklm JW,Conti VR,Blackstone EH,Myocardial Damage in Cardiac surgery.The New England Journal of Medicine July 19,1979:135.
2.顾瑞华,于昂,王仲伦,张化新.体外循环心脏不停跳心内直视手术.天津医药.1992:2:105-107.
3.何巍,林辉,陈铭武,周华富,吴文森,彭青云.心脏跳动中二尖瓣置换术 中华外科杂志.1996:34(11):678.
4.林辉,何巍,彭青云等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
5.Menasche P,eynei J,Haeffner-Cavaillon H,et al.Influence of temperature on neutrophic afficking during clinical cardiopulmonary bypass.Circulation,1995,92(suppl):Ⅱ334.
6.Kamlot A,Bellow SD,Simkhovich BZ,et al,Is warm wetrograde blood cardioplegia better than cold for myocardial protection.Ann Thorac Sury.1997:63(i):98-104.
7.Ting W,Spotnitz AJ,Mzckenine JW,et al.Protection of the acutely injuried heart deleterious effects of hypothermia.J Sury Res,1994:56(1):108.
8.何勇,陈龙,杨胜生等.心脏不停搏下实施高危心脏手术六例报告.第二军医大学学报,1999;20(12):1052.
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