Benedetto Umberto, Caputo Massimo, Guida Gustavo, Bucciarelli-Ducci Chiara, Thai Jade, Bryan Alan, Angelini Gianni D
Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK.
Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, UK.
Semin Thorac Cardiovasc Surg. 2017;29(3):301-310. doi: 10.1053/j.semtcvs.2017.05.002. Epub 2017 May 23.
Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac surgery, there is still paucity of evidence to prove its benefit in terms of neurologic protection. Therefore, we conducted a meta-analysis of available randomized controlled trials comparing CDI vs standard de-airing maneuvers. Electronic searches were performed to identify relevant randomized controlled trials. Primary outcomes investigated were postoperative stroke, neurocognitive deterioration, and in-hospital mortality. Risk difference (RD) was used as summary statistic. Pooled estimates were obtained by means of random-effects model to account for possible clinical diversity and methodological variation between studies. Eight studies were identified with 668 patients randomized to CDI (n = 332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was 2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95% confidence interval [CI] -2% to 2%; P = 0.87; I = 0%). Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62; I = 0%). Neurocognitive deterioration rate was 12% vs 21% in the CDI and control group, respectively, but this difference was not statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35; I = 0%). The present meta-analysis did not find any significant protective effect from the use of CDI when compared with manual de-airing maneuvers in terms of clinical outcomes, including postoperative neurocognitive decline.
尽管二氧化碳吹入法（CDI）在心脏手术中被广泛应用，但仍缺乏证据证明其在神经保护方面的益处。因此，我们对比较CDI与标准排气操作的现有随机对照试验进行了荟萃分析。通过电子检索来识别相关的随机对照试验。研究的主要结局指标为术后中风、神经认知功能恶化和住院死亡率。风险差异（RD）用作汇总统计量。采用随机效应模型获得合并估计值，以考虑研究之间可能存在的临床差异和方法学差异。共纳入8项研究，668例患者被随机分为CDI组（n = 332）和标准排气操作组（n = 336）。CDI组和对照组的住院死亡率分别为2.1%和3.0%（RD 0%；95%置信区间[CI] -2%至2%；P = 0.87；I² = 0%）。两组的中风发生率相似（CDI组和对照组分别为1.0%和1.2%；RD 0%；95% CI -1%至2%；P = 0.62；I² = 0%）。CDI组和对照组的神经认知功能恶化率分别为12%和21%，但这种差异无统计学意义（RD：-7%；95% CI -0.22%至8%；P = 0.35；I² = 0%）。与手动排气操作相比，本荟萃分析未发现使用CDI在包括术后神经认知功能下降在内的临床结局方面有任何显著的保护作用。
