Xiong Yaoyao, Sun Yanhua, Ji Bingyang, Liu Jinping, Wang Guyan, Zheng Zhe
Department of Cardiopulmonary Bypass, Cardiovascular Institute & Fuwai Heart Hospital, PUMC & CAMS, Beijing, China; Department of Cardiopulmonary Bypass, The Second XiangYa Hospital of Central South University, ChangSha, China.
Paediatr Anaesth. 2015 Feb;25(2):135-42. doi: 10.1111/pan.12560. Epub 2014 Oct 21.
The controversy over the benefits between normothermic and hypothermic cardiopulmonary bypass (CPB) for children is still uncertain. The purpose of this systematic review and meta-analysis is to investigate the benefits and risks of normothermia comparing with hypothermia in pediatric cardiac surgery by randomized controlled trials.
Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies reported in English up to September 28, 2013. Eligible studies were those in which investigators enrolled pediatric patients, who had cardiac surgery, randomized them to normothermic or hypothermic CPB. We prespecified the use of random-effects models to calculate risk ratios and 95% CIs for binary variables, weighted mean difference (WMD) or standard mean difference and 95% CIs for continuous variables. We assessed heterogeneity using I(2). When heterogeneity was absent (I(2) = 0%), we used fixed-effects models. The endpoints were serum lactate, serum creatinine, duration of clamp, and duration of CPB in pediatrics who had cardiac surgery in normothermic CPB compared with those in hypothermic CPB.
The initial search strategy identified 3910 citations, of which 10 trials compared pediatrics and seven trails were eligible. These seven trials included 419 participants from seven countries. The serum lactate and the serum creatinine had three time points. The outcomes had no different between normothermic group and hypothermic group. Duration of clamp (WMD = -10.793, 95% CI -28.89, 7.304; P = 0.242; I(2) = 86.6%; 204 patients, three trials) and duration of CPB (WMD = -41.780, 95% CI -89.523, 5.963; P = 0.086; I(2) = 95.6%; 199 patients, three trials) also had no significant differences between two groups.
Normothermic CPB is as safe as hypothermic CPB in children requiring correction of simple congenital cardiac defects.
对于儿童常规体温与低温体外循环（CPB）的益处存在的争议仍不明确。本系统评价和荟萃分析的目的是通过随机对照试验研究小儿心脏手术中常规体温与低温相比的益处和风险。
检索了截至2013年9月28日以英文发表的研究的PubMed、Embase和Cochrane对照试验中心注册库。符合条件的研究是那些研究者纳入接受心脏手术的儿科患者，并将他们随机分为常规体温或低温CPB的研究。我们预先指定使用随机效应模型来计算二元变量的风险比和95%置信区间（CI），连续变量的加权平均差（WMD）或标准化平均差和95%CI。我们使用I²评估异质性。当不存在异质性（I² = 0%）时，我们使用固定效应模型。终点指标为接受常规体温CPB的小儿心脏手术患者与接受低温CPB的患者相比的血清乳酸、血清肌酐、夹闭时间和CPB时间。
最初的检索策略识别出3910条引文，其中10项试验比较了儿科患者，7项试验符合条件。这7项试验包括来自7个国家的419名参与者。血清乳酸和血清肌酐有三个时间点。常规体温组和低温组的结果没有差异。夹闭时间（WMD = -10.793，95%CI -28.89，7.304；P = 0.242；I² = 86.6%；204例患者，3项试验）和CPB时间（WMD = -41.780，95%CI -89.523，5.963；P = 0.086；I² = 95.6%；199例患者，3项试验）在两组之间也没有显著差异。
对于需要矫正简单先天性心脏缺陷的儿童，常规体温CPB与低温CPB一样安全。
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