深低温停循环与选择性顺行性脑灌注中低温停循环的荟萃分析。
A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.
机构信息
The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia;
出版信息
Ann Cardiothorac Surg. 2013 Mar;2(2):148-58. doi: 10.3978/j.issn.2225-319X.2013.03.13.
INTRODUCTION
A recent concern of deep hypothermic circulatory arrest (DHCA) in aortic arch surgery has been its potential association with increased risk of coagulopathy, elevated inflammatory response and end-organ dysfunction. Recently, moderate hypothermic circulatory arrest (MHCA) with selective antegrade circulatory arrest (SACP) seeks to negate potential hypothermia-related morbidities, while maintaining adequate neuroprotection. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA or MHCA+SACP as neuroprotective strategies.
METHODS
Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA with MHCA+SACP, as defined by a recent hypothermia temperature consensus. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.
RESULTS
Nine comparative studies were identified for inclusion in the present meta-analysis. Stroke rates were significantly lower in patients undergoing MHCA+SACP (P=0.0007, I(2)=0%), while comparable results were observed with temporary neurological deficit, mortality, renal failure or bleeding. Infrequent and inconsistent reporting of systemic outcomes precluded analysis of other systemic outcomes.
CONCLUSIONS
The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.
简介
深低温停循环（DHCA）在主动脉弓手术中的一个新关注点是其与凝血功能障碍、炎症反应升高和终末器官功能障碍风险增加的潜在关联。最近，采用选择性顺行循环阻断（SACP）的中低温停循环（MHCA）试图消除潜在的低温相关疾病，同时保持足够的神经保护。本荟萃分析旨在比较使用 DHCA 或 MHCA+SACP 作为神经保护策略的弓部手术的术后结果。
方法
从数据库建立到 2013 年 1 月，使用六个数据库进行电子检索。两名审查员独立确定了所有比较 DHCA 与 MHCA+SACP 的相关研究，DHCA 和 MHCA+SACP 的定义是根据最近的低温共识。根据预先定义的临床终点提取和荟萃分析数据。
结果
确定了 9 项比较研究纳入本荟萃分析。接受 MHCA+SACP 的患者卒中发生率明显降低（P=0.0007，I(2)=0%），而暂时性神经功能缺损、死亡率、肾衰竭或出血的结果相似。系统结局的报告频率低且不一致，排除了对其他系统结局的分析。
结论
本荟萃分析表明，MHCA+SACP 在卒中风险方面具有优势。
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