含血停搏液与晶体停搏液对未成熟心肌保护作用的Meta分析
The Protection of Blood Cardioplegia and Crystalloid Cardioplegia on Myocardial of Immature: A Meta-Analysis

作者: 王石雄 * , 李宁荫 :兰州大学第二临床医学院; 曹云华 , 高秉仁 * , 吴向阳 , 柳德斌 , 陈文胜 , 赵启明 :兰州大学第二医院;

关键词: 停搏液未成熟心肌Meta分析Cardioplegia Immature Myocardium Meta-Analysis

摘要: 目的比较含血停搏液与晶体停搏液对未成熟心肌的保护作用。方法中国期刊全文数据库、中文科技期刊全文数据库,检索时间从各数据库建库至201012月;同时辅助其他检索,纳入比较含血停搏液与晶体停搏液对未成熟心肌的保护的随机对照试验(RCTs)。两名评价者独立评价纳入研究的质量并提取资料,并用RevMan 5.0软件进行统计分析。结果共纳入9RCTs共计340例患者。Meta分析结果显示:含血停搏液与晶体停搏液相比,在正性肌力药物依赖性(OR = 0.30, 95%CI(0.12, 0.8), P = 0.01)在心肌肌钙蛋白I术毕(MD = −35.98, 95%CI(−57.69, −14.27), P = 0.001)在心肌肌钙蛋白I术后24 h(MD = −16.97, 95%CI(−26.80, −7.14), P = 0.0007)在肌酸激酶同工酶术毕(MD = −3.61, 95%CI(−5.00, −2.21), P < 0.00001)在肌酸激酶同工酶术后24 h(MD = −12.77, 95%CI(−23.26, −2.27), P = 0.02)在肌酸激酶同工酶术后48 h(MD = −4.97, 95%CI(−9.38, −0.57), P = 0.03)方面的差异有统计学意义。在心脏自动复跳率(OR = 0.73, 95%CI(0.26, 2.08), P = 0.56)在心肌肌钙蛋白I术后48 h(MD = −2.06, 95%CI(−4.20, 0.08), P = 0.06)方面的差异无统计学意义。结论含血停搏液对未成熟心肌具有显著的保护,但鉴于纳入研究质量不高,仍需大样本多中心随机对照临床试验进一步证实其临床疗效。

Abstract: Objective: To compare the protection between blood cardioplegia and crystalloid cardioplegia on immature myocardial. Methods: We searched Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Da- tabase, and Chinese Journal Full-text Database up to December 2010 to identify randomized controlled trials (RCTs)comparing blood cardioplegia and crystalloid cardioplegia for immature myocardial. We evaluated the quality of the included studies and analyzed data by Cochrane Collaboration’s RevMan 5.0 software. Results: Nine RCTs involving 340 patients were included. The results of meta analysis suggested that there were significant differences between blood cardioplegia and crystalloid cardioplegia the dependence degrees of positive inotropic after operation in systolic (OR = 0.30, 95%CI (0.12, 0.8), P = 0.01), Serum troponin-I after operation (MD = −16.97, 95%CI (−26.80, −7.14), P = 0.0007), Serum troponin-I 24 hours after operation (MD = −16.97, 95%CI (−26.80, −7.14), P = 0.0007), MB isoenzyme of creatine kinase (CK-MB) after operation (MD = −3.61, 95%CI (−5.00, −2.21), P < 0.00001), MB isoenzyme of creatine kinase (CK-MB) 24 hours after operation (MD = −12.77, 95%CI (−23.26, −2.27), P = 0.02), MB isoenzyme of creatine kinase (CK-MB) 48 hours after operation (MD = −4.97, 95%CI (−9.38, −0.57), P = 0.03) There were not dif- ferences between blood cardioplegia and crystalloid cardioplegia automatic re-jump rate (OR = 0.73, 95%CI (0.26, 2.08), P = 0.56); Serum troponin-I 48 hours after operation (MD = −2.06, 95%CI (−4.20, 0.08), P = 0.06). Conclusion: The results of meta-analysis indicate that blood cardioplegia have significant effects in protection on immature myocar- dial, but due to the limitation of sample sight, and the quality of original studies, the effects of blood cardioplegia on immature myocardial need to be confirmed by large multi-center randomized controlled trials.

文章引用: 王石雄 , 李宁荫 , 曹云华 , 高秉仁 , 吴向阳 , 柳德斌 , 陈文胜 , 赵启明 (2013) 含血停搏液与晶体停搏液对未成熟心肌保护作用的Meta分析。 外科, 2, 6-12. doi: 10.12677/HJS.2013.21002

参考文献

[1] M. Nagai, K. Kamide, H. Rakugi, et al. Role of endothelin-1 in- duced by insul in the regulation of vascu1ar cell growth. Ameri- can Journal of Hypenens, 2003, 16(3): 223-238.

[2] D. C. Drinkwater, H. Laks. Pediatric cadioplegic techniques. Se- minars in Thoracic and Cardiovascular Surgery, 1993, 5: 168- 175.

[3] 李佳春, 李功宋, 主编. 体外循环灌注学[M]. 北京: 人民军医出版社,1993: 489-493.

[4] 胡小琴, 主编. 心血管麻醉及体外循环[M]. 北京: 人民卫生出版社, 1997: 247-252.

[5] J. P. T. Higgins, S. Cochrane handbook for systematic reviews of interventions version 5.0.2 [updated September 2009]. Oxford : The Cochrane Collaboration, 2008. www.cochrane-handbook.org.

[6] Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Cochrane Cencer, The Cochrane Collaboration, 2008.

[7] 苏肇伉, 万里飞, 曹鼎方等. 温血诱导心脏停搏及终末温血灌注在婴幼儿心内直视手术中的应用研究[J]. 中国胸心血管外科临床杂志, 1999, 2(6): 1-3.

[8] 于坤, 龙村, 刘迎龙等. 冷血停搏液对5岁以下儿童先天性心脏病心肌保护效果的观察[J]. Chinese Circulation Journal, 2001, 16(1): 58-60.

[9] 于坤, 刘迎龙, 龙村等. 冷血停搏液对法洛四联症婴幼儿心肌代谢的影响[J]. 中国胸心血管外科临床杂志, 2002, 47(12): 20-22.

[10] 王鹏高, 罗淑颖, 牛松涛等. 不同心脏停搏液对体外循环中未成熟心肌保护作用的研究[J]. 中国现代医生, 2009, 11(8): 638-640.

[11] 韩宏光, 张仁福, 汪曾炜等. 一体化综合心肌保护对缺血再灌注心肌超微结构改变的影响[J]. 中国临床康复, 2004, 8(18): 3500-3501.

[12] 张青, 孟保英, 彭乐等. 自体冷血停搏液对婴幼儿心肌保护机制的研究[J]. 中国当代儿科杂志, 2009, 11(8): 638-640.

[13] 张青, 王涛, 彭乐等. 自体冷血停搏液对婴幼儿心肌保护作用[J]. 中国体外循环杂志, 2009, 7(1): 1-3.

[14] 沈定荣, 王涛, 张青等. 字体冷血心脏停搏液对未成熟心肌CK-MB、cTnI及细胞线粒体的影响[J]. 中国医药指南, 2010, 8(20): 9-11.

[15] 沈定荣, 王涛, 张青等. 字体冷血心脏停搏液对未成熟心肌细胞ATP及三磷酸腺苷酶的影响[J]. 医学信息, 2010, 23(7): 16-17.

[16] 高秀梅, 张伯礼, 商洪才等. 复方丹参方预处理对心肌缺血再灌注损伤的保护作用[J]. 中国临床康复, 2003, 7(12): 1754- 1755.

[17] 徐延敏, 黄体钢, 陈元禄. 卡托普利对缺血——再灌注豚鼠乳头肌的直接电生理特征[J]. 中国临床康复, 2003, 7(12): 1758- 1759.

[18] 万里飞, 苏肇伉, 祝忠群等. 冷痉挛对未成熟心肌功能、能量代谢与超微结构的影响[J]. 临床心血管病杂志, 1999, 15(2): 77-80.

[19] 丁文祥, 苏肇伉. 小儿心脏外科学[M]. 济南: 山东科学技术出版社, 2000: 206-208.

[20] C. Sehlensak, T. Doenst, F. Beyersdorf, et al. Clinical experience with blood cardioplegia. The Thoracic and Cardiovascular Sur- geon, 1998, 46(Suppl 2): 282-271.

[21] 吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念, 实施与报告[J]. 中国循证医学杂志, 2007, 7(3): 222-224.

[22] K. F. Schulz, I. Chalmers, R. I. Hayes, et al. Empirical evidence of biasdimensions of methodological quality associated with es- timates of treatment effects in controlled trials. The Journal of the American Medical Association, 1995, 273(5): 408-412.

分享
Top