Department of Cardiothoracic and Vascular Surgery, Chongqing Xinqiao Hospital, Third Military Medical University, Chongqing, PR China.
Eur J Cardiothorac Surg. 2010 Apr;37(4):912-9. doi: 10.1016/j.ejcts.2009.09.030. Epub 2009 Oct 21.
Much controversy persists regarding the optimal techniques for myocardial protection during heart surgery. Numerous studies have compared warm cardioplegia with cold cardioplegia for myocardial preservation, but the outcomes were inconclusive. The aim of this meta-analysis of randomised controlled trials (RCTs) was to compare the beneficial and harmful effects of warm and cold cardioplegia during heart surgery. Electronic databases and manual bibliographical searches were conducted. A meta-analysis of all RCTs comparing warm cardioplegia to cold cardioplegia perfusion during cardiac surgery was performed. Data for clinical events (in-hospital death, myocardial infarction (MI), low output syndrome, postoperative use of intra-aortic balloon pump, stroke and atrial fibrillation), postoperative cardiac index, postoperative creatine kinase-MB (CK-MB) and cardiac troponin release were extracted, and we summarised the combined results of the data of the RCTs as relative risk (RR), with 95% confidence intervals. A total of 41 RCTs including 5,879 patients were assessed in this study. We found that there was no statistical difference between patients receiving warm cardioplegia and cold cardioplegia in the incidences of clinical events. Warm cardioplegia was associated with improved postoperative cardiac index. CK-MB and cardiac troponin concentrations after surgery were significantly lower in the warm group as compared with the cold group. Using warm cardioplegia for myocardial protection during heart surgery resulted in similar incidences of clinical events, significant improvement in postoperative cardiac index and reduction in postoperative enzyme release as compared with cold cardioplegia.
关于心脏手术中心肌保护的最佳技术仍存在许多争议。许多研究比较了温血停搏液与冷血停搏液在心肌保护方面的作用，但结果尚无定论。本项随机对照试验（RCT）荟萃分析旨在比较心脏手术中温血和冷血停搏液的有益和有害作用。通过电子数据库和手工文献检索进行研究。对所有比较心脏手术中温血停搏液与冷血停搏液灌注的 RCT 进行荟萃分析。提取临床事件（院内死亡、心肌梗死（MI）、低心排综合征、术后使用主动脉内球囊泵、卒中和心房颤动）、术后心脏指数、术后肌酸激酶同工酶-MB（CK-MB）和心肌肌钙蛋白释放的数据，并汇总 RCT 数据的综合结果作为相对风险（RR）和 95%置信区间。本研究共评估了 41 项 RCT，涉及 5879 例患者。我们发现，接受温血停搏液和冷血停搏液的患者在临床事件发生率方面没有统计学差异。温血停搏液与术后心脏指数改善相关。与冷血停搏液相比，温血停搏液组术后 CK-MB 和心肌肌钙蛋白浓度明显较低。与冷血停搏液相比，在心脏手术中心肌保护中使用温血停搏液可导致相似的临床事件发生率、术后心脏指数的显著改善和术后酶释放的减少。
