Volpi Sara, Ali Jason M, De Silva Ravi
Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK.
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):473-477. doi: 10.1093/icvts/ivy266.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Does the use of a 'hot-shot' (terminal warm blood cardioplegia) lead to improved outcomes following adult cardiac surgery? Altogether, 567 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that evidence supporting the use of a hot-shot prior to weaning from cardiopulmonary bypass is rather limited. All 8 of the randomized trials to date are small studies which examine heterogeneous groups of patients, and unfortunately, the conclusions are inconsistent, perhaps in part related to the inability to demonstrate statistical significance with small group size. From the evidence, it appears likely that the use of a hot-shot results in more rapid biochemical, electrical and possibly functional myocardial recovery from cardiopulmonary bypass. However, no study has been able to demonstrate that this leads to improved clinical outcomes other than lower incidence of atrial fibrillation.
一篇心脏外科领域的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是：在成人心脏手术后，使用“热射流”（终末温血心脏停搏液）是否能改善预后？通过报告的检索方式共找到567篇论文，其中9篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、发表日期和国家、所研究的患者群体、研究类型、相关结局和结果都列于表格中。我们得出结论，支持在体外循环脱机前使用热射流的证据相当有限。迄今为止的所有8项随机试验都是小型研究，研究的患者群体异质性较大，不幸的是，结论并不一致，这可能部分与样本量小无法显示统计学显著性有关。从证据来看，使用热射流似乎能使体外循环后的心肌在生化、电生理以及可能在功能方面更快恢复。然而，除了房颤发生率较低外，没有研究能够证明这会改善临床结局。
