Chai Qing, Liu Jin
Qing Chai, PhD, Department of Critical Medicine and Anesthesiology, West China Hospital, Sichuan University, Sichuan Province, China.
Jin Liu, MD, Department of Critical Medicine and Anesthesiology, West China Hospital, Sichuan University, Sichuan Province, China.
Pak J Med Sci. 2014 May;30(3):642-8. doi: 10.12669/pjms.303.4292.
During the on-pump coronary artery bypass grafts surgery, ischemia/reperfusion injury would happen. Ischemia preconditioning could increase the tolerance against subsequent ischemia and reduce the ischemia/reperfusion injury. However the clinical outcomes of the available trials were different. Methods : We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2013), the Medline/PubMed and CNKI in March 2013. RevMan 5.1.6 and GRADEprofiler 3.6 were used for statistical analysis and evidence quality assessment. Heterogeneity was evaluated with significance set at P≤0.10.
Eighteen randomized controlled trials were included. There were no differences on in-hospital mortality, postoperative myocardial infarction morbidity between ischemia preconditioning and control groups. The heterogeneity of creatine kinase-MB level 24 hours after surgery was obvious. The differences of 72 hours area under the curve of cardiac troponin T (mean differences of -14.50, 95% confidence interval of -21.71 to -7.28) and troponin I (mean differences -181.79, 95% confidence interval of -270.07 to -93.52) after surgery were observed. Conclusion s : All the 18 trails, the positive and the negative results were equal. The meta-analysis results should be interpreted with caution due to limited effective data. Because of high cost-effectiveness, ischemia preconditioning could not be denied completely. Large-scale randomized studies are needed, with the operation procedures and included criteria being more specific.
在心脏不停跳冠状动脉搭桥手术期间，会发生缺血/再灌注损伤。缺血预处理可提高对后续缺血的耐受性并减少缺血/再灌注损伤。然而，现有试验的临床结果各不相同。方法：我们检索了2013年3月《考克兰图书馆》（第3期）考克兰对照试验中央登记库、Medline/PubMed和中国知网。使用RevMan 5.1.6和GRADEprofiler 3.6进行统计分析和证据质量评估。采用P≤0.10作为异质性评估的显著性水平。
纳入18项随机对照试验。缺血预处理组和对照组在住院死亡率、术后心肌梗死发病率方面无差异。术后24小时肌酸激酶-MB水平的异质性明显。观察到术后心脏肌钙蛋白T曲线下72小时面积的差异（平均差异为-14.50，95%置信区间为-21.71至-7.28）以及肌钙蛋白I的差异（平均差异为-181.79，95%置信区间为-270.07至-93.52）。结论：在所有18项试验中，阳性和阴性结果相当。由于有效数据有限，对荟萃分析结果的解释应谨慎。鉴于高成本效益，缺血预处理不能被完全否定。需要开展大规模随机研究，使手术程序和纳入标准更具特异性。
