Xiong Tao, Pu Lei, Ma Yuan-Feng, Zhu Yun-Long, Cui Xu, Li Hua, Zhan Xu, Li Ya-Xiong
Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.
Cardiovascular Surgery, Institution of Yunnan, Kunming, China.
Front Pediatr. 2021 Dec 14;9:757551. doi: 10.3389/fped.2021.757551. eCollection 2021.
Hypothermic cardiopulmonary bypass (HCPB) has been used successfully in cardiac surgery for more than half a century, although adverse effects have been reported with its use. Many studies on temperature management during CPB published to date have shown that normothermic CPB (NCPB) provides more benefits to children undergoing cardiac surgery. The present meta-analysis investigated the effect of NCPB on clinical outcomes based on results of randomized controlled trials and observational studies on pediatric cardiac surgery. Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov were searched from inception to May 2021 to identify relevant studies published in English. The present meta-analysis included 13 studies characterizing a total of 837 pediatric patients. The random effects model exhibited that the NCPB group had reduced revision for postoperative bleeding [odds ratio (OR): 0.11; 95% confidence interval (CI): 0.01-0.89; = 0%, = 0.04], serum lactate 2-4 h after CPB (mean difference: -0.60; 95% CI: -1.09 to -0.11; = 82%, = 0.02), serum creatinemia 24 h after CPB (mean difference: -2.73; 95% CI: -5.06 to -0.39; = 83%, = 0.02), serum creatinemia 48 h after CPB (mean difference: -2.08; 95% CI: -2.78 to -1.39; = 0%, < 0.05), CPB time (mean difference: -19.10, 95% CI: -32.03 to -6.18; = 96%, = 0.04), and major adverse events (OR: 0.37; 95% CI: 0.15-0.93; = 2.12, = 0.03) after simple congenital surgery compared with the HCPB group. NCPB is as safe as HCPB in pediatric congenital heart surgery. Moreover, NCPB provides more advantages than HCPB in simple congenital heart surgery.
低温体外循环（HCPB）已在心脏手术中成功应用了半个多世纪，尽管使用过程中报告了一些不良反应。迄今为止发表的许多关于体外循环期间温度管理的研究表明，常温体外循环（NCPB）对接受心脏手术的儿童更有益。本荟萃分析基于小儿心脏手术的随机对照试验和观察性研究结果，调查了NCPB对临床结局的影响。检索了PubMed、EMBASE、Cochrane对照试验中央注册库和ClinicalTrials.gov等数据库，从建库至2021年5月，以识别用英文发表的相关研究。本荟萃分析纳入了13项研究，共涉及837例儿科患者。随机效应模型显示，与HCPB组相比，NCPB组术后出血的再次手术率降低[比值比（OR）：0.11；95%置信区间（CI）：0.01 - 0.89；I² = 0%，P = 0.04]，体外循环后2 - 4小时血清乳酸水平降低（平均差值：-0.60；95% CI：-1.09至-0.11；I² = 82%，P = 0.02），体外循环后24小时血清肌酐水平降低（平均差值：-2.73；95% CI：-5.06至-0.39；I² = 83%，P = 0.02），体外循环后48小时血清肌酐水平降低（平均差值：-2.08；95% CI：-2.78至-1.39；I² = 0%，P < 0.05），体外循环时间缩短（平均差值：-19.10，95% CI：-32.03至-6.18；I² = 96%，P = 0.04），简单先天性手术术后主要不良事件发生率降低（OR：0.37；95% CI：0.15 - 0.93；I² = 2.12，P = 0.03）。在小儿先天性心脏手术中，NCPB与HCPB一样安全。此外，在简单先天性心脏手术中，NCPB比HCPB具有更多优势。
