Division of Pediatric Anesthesia, International University of Health and Welfare Hospital, Tochigi, Japan.
J Thorac Cardiovasc Surg. 2011 Oct;142(4):861-7. doi: 10.1016/j.jtcvs.2011.04.001. Epub 2011 May 5.
Although previous studies have demonstrated that modified ultrafiltration improves laboratory parameters in pediatric cardiac surgery, the clinical outcome data have been inconsistent. We performed a meta-analysis of randomized controlled trials comparing modified versus conventional ultrafiltration.
We conducted a comprehensive search of the literature to identify clinical trials that met our inclusion criteria. To be included, studies had to be prospective randomized trials that compared modified ultrafiltration and conventional ultrafiltration in pediatric cardiac surgery using cardiopulmonary bypass. We focused on the following outcome variables: hematocrit and mean arterial blood pressure after cardiopulmonary bypass, amount of chest tube drainage after surgery, time to extubation, and length of stay in the intensive care unit. The random effects model was used to determine the pooled effect estimates. The estimators of treatment effects were expressed as the weighted mean difference with 95% confidence intervals. The heterogeneity of collected data was also evaluated.
We screened 54 studies, 8 of which satisfied our inclusion criteria. Combined analysis revealed that modified ultrafiltration resulted in significantly higher postbypass hematocrit and higher mean arterial blood pressure. Benefits in postoperative blood loss, ventilator time, and intensive care unit stay were not apparent. There was significant heterogeneity among the studies surveyed.
The advantage of modified ultrafiltration over conventional ultrafiltration consists of significant improvement of clinical conditions in the immediate postbypass period. The postoperative outcome parameters were not significantly influenced. We should also take into account possible clinical or methodologic variations in the currently available ultrafiltration studies.
尽管先前的研究表明改良超滤可改善儿科心脏手术中的实验室参数，但临床结果数据却不一致。我们对比较改良超滤与传统超滤的随机对照试验进行了荟萃分析。
我们全面搜索了文献，以确定符合我们纳入标准的临床试验。纳入研究必须是前瞻性随机试验，比较体外循环下心肺转流术中改良超滤与传统超滤。我们关注以下结局变量：体外循环后血细胞比容和平均动脉血压、手术后胸腔引流管引流量、拔管时间和重症监护病房住院时间。采用随机效应模型确定汇总效应估计值。治疗效果的估计值表示为加权均数差值及其 95%置信区间。还评估了收集数据的异质性。
我们筛选了 54 项研究，其中 8 项符合纳入标准。综合分析表明，改良超滤可显著提高体外循环后的血细胞比容和平均动脉血压。术后失血、呼吸机时间和重症监护病房住院时间的改善不明显。调查的研究存在显著的异质性。
改良超滤与传统超滤相比的优势在于显著改善体外循环后即刻的临床状况。术后结局参数无显著影响。我们还应考虑目前超滤研究中可能存在的临床或方法学差异。
