Intensive Care Specialist, Department of Intensive Care Medicine, Royal Perth Hospital, Perth, WA 6000, Australia.
Cardiovasc Ther. 2011 Aug;29(4):260-79. doi: 10.1111/j.1755-5922.2009.00114.x. Epub 2009 Dec 23.
Cardiopulmonary bypass is associated with significant morbidities, and the ideal temperature management during cardiopulmonary bypass remains uncertain. This review assessed the benefits and risks of maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery. A total of 6,731 patients from 44 randomized controlled trials in 14 countries, comparing normothermic (> 34°C) and hypothermic (≤34°C) cardiopulmonary bypass in cardiac surgery (>18 years of age), were identified from MEDLINE (1966 to August 10, 2009), EMBASE (1988 to August 10, 2009), and Cochrane controlled trials register and subject to meta-analysis. Two investigators examined all studies and extracted the data independently. Mortality after normothermic and hypothermic bypass was not significantly different (1.4% vs. 1.9% respectively, relative risk [RR] 1.38, 95% confidence interval [CI] 0.94-2.04, I(2) = 0%, P = 0.10). Hypothermic bypass was, however, associated with an increased risk of allogeneic red blood cells (RR 1.19, 95% CI 1.07-1.34, I(2) = 0%, P = 0.002), fresh frozen plasma (RR 1.54, 95% CI 1.06-2.24, I(2) = 7.7%, P = 0.02), and platelet transfusion (RR 2.53, 95% CI 1.26-5.06, I(2) = 44%, P = 0.009). The risk of stroke, cognitive decline, atrial fibrillation, use of inotropic support or intra-aortic balloon pump, myocardial infarction, all-cause infections, and acute kidney injury after cardiac surgery was not significantly different between the two groups. The differences in the bypass time and targeted perfusion temperature were not significantly related to the risk of mortality and stroke. The current evidence suggests that maintaining normothermia during cardiopulmonary bypass in adult cardiac surgery is as safe as that of hypothermic surgery, and associated with a reduced risk of allogeneic blood transfusion.
体外循环与显著的发病率相关，体外循环期间理想的体温管理仍不确定。本综述评估了在成人心脏手术中维持体外循环期间体温正常的益处和风险。从 MEDLINE（1966 年至 2009 年 8 月 10 日）、EMBASE（1988 年至 2009 年 8 月 10 日）和 Cochrane 对照试验登记处中检索到 44 项随机对照试验共 6731 名患者，这些试验比较了成人心脏手术（年龄大于 18 岁）中体温正常（＞34°C）和体温过低（≤34°C）的体外循环。两名研究者检查了所有的研究并独立地提取数据。体外循环后体温正常和体温过低的死亡率无显著差异（分别为 1.4%和 1.9%，相对危险度 [RR] 1.38，95%置信区间 [CI] 0.94-2.04，I² = 0%，P = 0.10）。然而，体外循环低温与异体红细胞（RR 1.19，95%CI 1.07-1.34，I² = 0%，P = 0.002）、新鲜冷冻血浆（RR 1.54，95%CI 1.06-2.24，I² = 7.7%，P = 0.02）和血小板输注（RR 2.53，95%CI 1.26-5.06，I² = 44%，P = 0.009）的输注风险增加相关。心脏手术后的卒中、认知能力下降、房颤、使用正性肌力药物或主动脉内球囊泵、心肌梗死、全因感染和急性肾损伤的风险在两组之间无显著差异。体外循环时间和目标灌注温度的差异与死亡率和卒中风险无显著关系。目前的证据表明，在成人心脏手术中维持体外循环期间体温正常与低温手术一样安全，并与异体输血风险降低相关。
