Geng Jun, Qian Ju, Si Weijun, Cheng Hao, Ji Fuhai, Shen Zhenya
Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Jiangsu Province's Key Medical Center for Cardiovascular Surgery, Suzhou, Jiangsu, China.
Interact Cardiovasc Thorac Surg. 2017 Dec 1;25(6):966-974. doi: 10.1093/icvts/ivx178.
The clinical benefits of perioperative antioxidant vitamin therapy in cardiac patients remain controversial. Here, we conducted a meta-analysis to determine the strength of the evidence supporting the perioperative use of antioxidant vitamins in patients undergoing cardiac surgery. We searched 4 databases (PubMed, EMBASE, Science Citation Index and Cochrane Library) for randomized controlled trials that reported the effects of antioxidant vitamin therapy on patients undergoing cardiac surgery until 6 June 2016. Risk ratio (RR) or mean difference (MD) and its 95% confidence interval (95% CI) served as the summarized results. Heterogeneity among included studies was evaluated using the I2 statistic, which help determine which effect model to apply. We constructed a funnel plot to assess the existence of publication bias. Sensitivity analyses were also conducted to evaluate the robustness of the outcomes. Twelve trials with 1584 cardiac patients were included. Compared with placebo or no antioxidant vitamin therapy, administration of antioxidant vitamin therapy resulted in a reduction in postoperative atrial fibrillation (POAF) (RR 0.55, 95% CI 0.42, 0.73, P < 0.0001), duration of hospital stay (MD -0.68, 95% CI -0.98, -0.39, P < 0.00001), intensive care unit length of stay (MD -0.21, 95% CI -0.30, -0.12, P < 0.00001) and intubation time (MD -2.41, 95% CI -3.83, -0.98, P = 0.001). Our results also showed a trend towards a decrease in postoperative complications (RR 0.72, 95% CI 0.48, 1.08, P = 0.11) and duration of POAF (MD -1.950, 95% CI -3.28, 0.29, P = 0.10). This meta-analysis demonstrated that perioperative antioxidant vitamin therapy in patients undergoing cardiac surgery can reduce the incidence of POAF, duration of hospital stay, intensive care unit length of stay and intubation time.
围手术期抗氧化维生素疗法对心脏病患者的临床益处仍存在争议。在此，我们进行了一项荟萃分析，以确定支持在心脏手术患者中围手术期使用抗氧化维生素的证据强度。我们检索了4个数据库（PubMed、EMBASE、科学引文索引和Cochrane图书馆），查找截至2016年6月6日报告抗氧化维生素疗法对心脏手术患者影响的随机对照试验。风险比（RR）或平均差（MD）及其95%置信区间（95%CI）作为汇总结果。使用I²统计量评估纳入研究之间的异质性，这有助于确定应用哪种效应模型。我们构建了漏斗图以评估发表偏倚的存在。还进行了敏感性分析以评估结果的稳健性。纳入了12项试验，共1584例心脏手术患者。与安慰剂或不进行抗氧化维生素疗法相比，给予抗氧化维生素疗法可降低术后房颤（POAF）发生率（RR 0.55，95%CI 0.42，0.73，P＜0.0001）、住院时间（MD -0.68，95%CI -0.98，-0.39，P＜0.00001）、重症监护病房住院时间（MD -0.21，95%CI -0.30，-0.12，P＜0.00001）和插管时间（MD -2.41，95%CI -3.83，-0.98，P = 0.001）。我们的结果还显示术后并发症有减少趋势（RR 0.72，95%CI 0.48，1.08，P = 0.11）以及POAF持续时间有减少趋势（MD -1.950，95%CI -3.28，0.29），P = 0.10）。这项荟萃分析表明，心脏手术患者围手术期抗氧化维生素疗法可降低POAF发生率、住院时间、重症监护病房住院时间和插管时间。
