深低温停循环与选择性顺行脑灌注联合应用的荟萃分析。
A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion.
机构信息
Collaborative Research (CORE) Group, Sydney, Australia;
出版信息
Ann Cardiothorac Surg. 2013 May;2(3):261-70. doi: 10.3978/j.issn.2225-319X.2013.05.11.
INTRODUCTION
Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA alone or DHCA + SACP as neuroprotection strategies.
METHODS
Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA alone with DHCA + SACP. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.
RESULTS
Nine comparative studies were identified in the present meta-analysis, with 648 patients employing DHCA alone and 370 utilizing DHCA + SACP. No significant differences in temporary or permanent neurological outcomes were identified. DHCA + SACP was associated with significantly better survival outcomes (P=0.008, I(2)=0%), despite longer cardiopulmonary bypass time. Infrequent and inconsistent reporting of other clinical results precluded analysis of systemic outcomes.
CONCLUSIONS
The present meta-analysis indicate the superiority of DHCA + SACP in terms of mortality outcomes.
简介
认识到在主动脉弓手术中神经保护的重要性，深低温停循环（DHCA）现在作为操作实践的基础，因为它最大限度地降低了大脑的代谢活动。当需要长时间的循环停止时，补充选择性顺行脑灌注（SACP）作为辅助。然而，SACP 引入栓塞和脑低灌注和高灌注的风险仍然存在。本荟萃分析旨在比较使用 DHCA 单独或 DHCA + SACP 作为神经保护策略的弓部手术的术后结果。
方法
使用六个数据库从其成立到 2013 年 1 月进行电子搜索。两位审查员独立识别了所有比较 DHCA 单独与 DHCA + SACP 的相关研究。根据预先定义的临床终点提取和荟萃分析数据。
结果
本荟萃分析确定了 9 项比较研究，其中 648 例患者采用 DHCA 单独，370 例采用 DHCA + SACP。在暂时或永久性神经功能结果方面没有发现显著差异。尽管体外循环时间更长，但 DHCA + SACP 与更好的生存结果相关（P=0.008，I(2)=0%）。其他临床结果的报告频率低且不一致，因此无法分析系统结果。
结论
本荟萃分析表明，DHCA + SACP 在死亡率结果方面具有优越性。
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