用于心肌保护和保存的心肌保护液：一项系统评价
Custodiol for myocardial protection and preservation: a systematic review.
作者信息
Edelman J James B, Seco Michael, Dunne Ben, Matzelle Shannon J, Murphy Michelle, Joshi Pragnesh, Yan Tristan D, Wilson Michael K, Bannon Paul G, Vallely Michael P, Passage Jurgen
机构信息
Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia;
The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia;
出版信息
Ann Cardiothorac Surg. 2013 Nov;2(6):717-28. doi: 10.3978/j.issn.2225-319X.2013.11.10.
INTRODUCTION
Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant.
METHODS
Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant.
RESULTS
Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant.
CONCLUSIONS
Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.
引言
科停德心肌保护液对微创心脏手术具有吸引力，因为单次给药可提供长时间的心肌保护。尽管在欧洲广泛使用，但与传统（血液或晶体）心肌保护液相比，证实其疗效的数据很少。在器官移植保存中使用它也有类似的热情，但同样缺乏数据。本系统评价旨在评估科停德在心肌保护以及作为心脏移植保存液方面疗效的证据。
方法
对6个数据库从创建至2013年10月进行电子检索。评价者独立识别将科停德与传统心肌保护液（血液或细胞外晶体液）在成年患者中进行比较的研究以进行荟萃分析；分析报告使用科停德结果的大型病例系列。接下来，我们识别将科停德与其他器官保存液在心脏移植器官保存中进行比较的研究。
结果
14项研究将科停德与传统心肌保护液在成人心脏手术中进行心肌保护比较。在死亡率方面未发现差异；科停德组室颤发生率有增加趋势，但未达到统计学意义。在将科停德与其他心脏移植保存液进行比较的研究中未发现差异。
结论
尽管临床广泛使用，但支持科停德在心肌保护或器官保存方面优于其他溶液的证据有限。需要进行大型随机试验。
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