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心脏手术中温血与冷血心脏停搏液的比较：一项采用序贯试验分析的荟萃分析

Warm versus cold cardioplegia in cardiac surgery: A meta-analysis with trial sequential analysis.

作者信息

Kot Thompson Ka Ming, Chan Jeffrey Shi Kai, Froghi Saied, Lau Dawnie Ho Hei, Morgan Kara, Magni Francesco, Harky Amer

机构信息

Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.

Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

出版信息

JTCVS Open. 2021 Mar 31;6:161-190. doi: 10.1016/j.xjon.2021.03.011. eCollection 2021 Jun.

DOI:10.1016/j.xjon.2021.03.011
PMID:36003589
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9390447/
Abstract

OBJECTIVE

This meta-analysis aimed to compare clinical outcomes of warm and cold cardioplegia in cardiac surgeries in adult patients, with trial sequential analysis (TSA) used to determine the conclusiveness of the results.

METHODS

Electronic searches were performed on PubMed, Medline, Scopus, EMBASE, and Cochrane library to identify all studies that compared warm and cold cardioplegia in cardiac surgeries. Primary end points were in-hospital or 30-day mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, and new atrial fibrillation. Secondary end points were acute kidney injury, hospital length of stay, and intensive care unit length of stay. Prespecified subgroup analyses were performed for (1) studies published since publication of Fan and colleagues in 2010, (2) randomized controlled studies, (3) studies with low risk of bias, (4) coronary artery bypass graft surgeries, and (5) studies with cold blood versus those with cold crystalloid cardioplegia. TSA was performed to determine conclusiveness of the results, using on all outcomes without significant heterogeneity from studies of low risk of bias.

RESULTS

No significant differences were found between post-operative rates of mortality, myocardial infarction, low cardiac output syndrome, intra-aortic balloon pump use, stroke, new atrial fibrillation, and acute kidney injury between warm and cold cardioplegia. TSA concluded that current evidence was sufficient to rule out a 20% relative risk reduction in these outcomes.

CONCLUSIONS

Concerning safety outcomes, current evidence suggests that the choice between warm and cold cardioplegia remains in the surgeon's preference.

摘要

目的

本荟萃分析旨在比较成人心脏手术中温血停搏液和冷血停搏液的临床结局，并采用序贯试验分析（TSA）来确定结果的确定性。

方法

对PubMed、Medline、Scopus、EMBASE和Cochrane图书馆进行电子检索，以识别所有比较心脏手术中温血停搏液和冷血停搏液的研究。主要终点为住院或30天死亡率、心肌梗死、低心排血量综合征、主动脉内球囊泵使用、中风和新发房颤。次要终点为急性肾损伤、住院时间和重症监护病房住院时间。对以下方面进行预设亚组分析：（1）2010年Fan及其同事发表文章之后发表的研究；（2）随机对照研究；（3）偏倚风险低的研究；（4）冠状动脉旁路移植手术；（5）冷血停搏液与冷晶体停搏液的研究。采用TSA来确定结果的确定性，对偏倚风险低的研究中所有无显著异质性的结局进行分析。

结果

温血停搏液和冷血停搏液术后死亡率、心肌梗死、低心排血量综合征、主动脉内球囊泵使用、中风、新发房颤和急性肾损伤发生率之间无显著差异。TSA得出结论，目前的证据足以排除这些结局中相对风险降低20%的情况。

结论

关于安全性结局，目前的证据表明，温血停搏液和冷血停搏液之间的选择仍取决于外科医生的偏好。

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