Department of Cardiology, Institute of Cardiovascular Diseases, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
BMC Cardiovasc Disord. 2012 Aug 19;12:67. doi: 10.1186/1471-2261-12-67.
Postoperative atrial fibrillation (POAF) is one of the most common complications in patients undergoing coronary artery bypass grafting (CABG). The goal of this meta-analysis was to evaluate the efficacy of thoracic epidural anesthesia (TEA) in preventing POAF in adult patients undergoing CABG.
MEDLINE and EMBASE were searched to identify randomized controlled trails in adult patients undergoing CABG who were randomly assigned to receive general anesthesia plus thoracic epidural anesthesia (GA + TEA) or general anesthesia only (GA). Two authors independently extracted data using a standardized Excel file. The primary outcome measure was the incidence of POAF. We used DerSimonian-Laird random-effects models to compute summary risk ratios with 95% confidence intervals.
Five studies involving 540 patients met our inclusion criteria. No significant difference in the incidence of POAF was observed between the two groups (risk ratio, 0.61; 95% confidence interval, 0.33 to 1.12; P = 0.11), with significant heterogeneity among the studies (I2 = 73%, P = 0.005). Sensitivity analyses by primary endpoint, methodological quality and surgical technique yielded similar results.
The limited evidence suggests that TEA shows no beneficial efficacy in preventing POAF in adult patients undergoing CABG. However, the results of this meta-analysis should be interpreted with caution due to significant heterogeneity of the studies included. Thus, the potential infuence of TEA on the incidence of atrial fibrillation following CABG warrants further investigation.
术后心房颤动（POAF）是行冠状动脉旁路移植术（CABG）患者最常见的并发症之一。本荟萃分析的目的是评估胸段硬膜外麻醉（TEA）预防成人 CABG 患者 POAF 的疗效。
检索 MEDLINE 和 EMBASE 数据库，以确定行 CABG 的成年患者的随机对照试验，这些患者被随机分为接受全身麻醉加胸段硬膜外麻醉（GA+TEA）或全身麻醉（GA）。两位作者使用标准化的 Excel 文件独立提取数据。主要结局指标是 POAF 的发生率。我们使用 DerSimonian-Laird 随机效应模型计算汇总风险比及其 95%置信区间。
符合纳入标准的有 5 项研究，共涉及 540 例患者。两组间 POAF 的发生率无显著差异（风险比，0.61；95%置信区间，0.33 至 1.12；P=0.11），但研究之间存在显著异质性（I2=73%，P=0.005）。通过主要终点、方法学质量和手术技术进行的敏感性分析得出了相似的结果。
有限的证据表明，TEA 对预防成人 CABG 患者 POAF 没有有益效果。然而，由于纳入研究的异质性显著，该荟萃分析的结果应谨慎解释。因此，TEA 对 CABG 后心房颤动发生率的潜在影响需要进一步研究。
