Guru Veena, Omura John, Alghamdi Abdullah A, Weisel Richard, Fremes Stephen E
Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, H-410, Toronto, Ontario M4N 3M5 Canada.
Circulation. 2006 Jul 4;114(1 Suppl):I331-8. doi: 10.1161/CIRCULATIONAHA.105.001644.
Many small, randomized, controlled trials have evaluated the effectiveness of blood as compared with crystalloid cardioplegia for myocardial protection during cardiac surgery. Blood cardioplegia provides a closer approximation to normal physiology, which may translate into measurable clinical benefits. This meta-analysis describes the effectiveness of blood cardioplegia in lowering adverse postoperative outcomes.
MEDLINE, EMBASE, and the Cochrane registry of controlled trials were searched for clinical trials. The search was restricted to peer-reviewed English language publications of randomized controlled trials that primarily compared blood and crystalloid cardioplegia in adult patients. Each trial was blindly assessed and abstracted by 2 reviewers. The primary outcomes were: low output syndrome (LOS), myocardial infarction (MI), and death. Surrogate outcomes included postoperative creatinine kinase MB (CKMB) increase. Random effects summary odds ratio (OR) for binary outcomes, and weighted mean difference for continuous outcomes were calculated. A total of 34 trials were included. The majority of trials were conducted in patients undergoing elective CABG surgery (n=18). The incidence of LOS was decreased significantly with blood cardioplegia (OR, 0.54; 95% confidence interval [CI], 0.34 to 0.84; P=0.006; 879 patients, 10 trials). The incidence of MI and death were similar between treatment groups (MI: OR, 0.78; 95% CI, 0.54 to 1.13; 4316 patients, 23 trials) (death: OR, 0.80; 95% CI, 0.46 to 1.40; 4022 patients, 17 trials). CKMB release after surgery at 24 hours was reduced with blood cardioplegia (5.9 U/L; 95% CI, 1.6 to 10.2; P=0.007; 821 patients, 7 trials).
Blood cardioplegia provides superior myocardial protection as compared with crystalloid cardioplegia, including lower rates of LOS, and early CKMB increase, whereas the incidence of myocardial infarction and death are similar.
许多小型随机对照试验评估了心脏手术期间血液停搏液与晶体停搏液相比在心肌保护方面的有效性。血液停搏液更接近正常生理状态，这可能转化为可衡量的临床益处。本荟萃分析描述了血液停搏液在降低术后不良结局方面的有效性。
检索MEDLINE、EMBASE和Cochrane对照试验注册库以查找临床试验。检索仅限于主要比较成年患者血液停搏液和晶体停搏液的随机对照试验的同行评审英文出版物。每项试验由2名评审员进行盲法评估和提取。主要结局为：低心排血量综合征（LOS）、心肌梗死（MI）和死亡。替代结局包括术后肌酸激酶MB（CKMB）升高。计算二元结局的随机效应汇总比值比（OR）和连续结局的加权平均差。共纳入34项试验。大多数试验在接受择期冠状动脉旁路移植术（CABG）的患者中进行（n = 18）。血液停搏液使LOS发生率显著降低（OR，0.54；95%置信区间[CI]，0.34至0.84；P = 0.006；879例患者，10项试验）。治疗组之间MI和死亡的发生率相似（MI：OR，0.78；95%CI，0.54至1.13；4316例患者，23项试验）（死亡：OR，0.80；95%CI，0.46至1.40；4022例患者，17项试验）。血液停搏液使术后24小时的CKMB释放减少（5.9 U/L；95%CI，1.6至10.2；P = 0.007；821例患者，7项试验）。
与晶体停搏液相比，血液停搏液提供了更好的心肌保护，包括更低的LOS发生率和早期CKMB升高，而心肌梗死和死亡的发生率相似。
