远隔缺血预处理联合不同麻醉方式对缺血-再灌注心肌损伤影响的Meta分析

发布时间：2019-07-09 09:16

【摘要】：目的系统评价心血管手术中远隔缺血预处理(RIPC)联合不同麻醉方式对缺血-再灌注心肌损伤(IRI)的影响。方法检索PubMed、Embase、Cochrane Library数据库,根据纳入、排除标准检出相关随机对照研究文献。采用RevMan 5.3及STATA 12.0软件进行Meta分析。结果纳入研究10篇,共969例患者。RIPC可以减少术后肌钙蛋白峰值水平[SMD=-0.16,95%CI(-0.29,-0.03)]。单个协变量Meta回归分析显示女性占比、年龄和β受体阻断药与研究间异质性有关,肌钙蛋白种类、糖尿病、高血压、高脂血症等未对异质性造成影响。以麻醉维持期间药物使用分组:吸入性麻醉药组:SMD=-0.40,95%CI(-0.66,-0.14),吸入性麻醉药复合丙泊酚组:SMD=-0.04,95%CI(-0.20,0.12),丙泊酚组:SMD=-0.29,95%CI(-0.87,0.30)。术后转归(ICU时间、通气时间、强心药使用、房颤发生、住院时间)差异无统计学意义。结论联合使用RIPC与吸入性麻醉药可以降低心血管术后肌钙蛋白释放峰值,但对术后转归无明显影响。
[Abstract]:Objective To evaluate the effect of long-distance ischemic preconditioning (RIPC) on the myocardial injury (IRI) of ischemia-reperfusion in cardiovascular surgery. Methods The PubMed, Embase, Cochrane Library database was searched and the relevant randomized controlled studies were checked out according to the inclusion and exclusion criteria. Meta-analysis was performed using the RevMan 5.3 and the STATA 12.0 software. The results were included in 10 studies, with a total of 969 patients. The RIPC can reduce the post-operative troponin peak level[SMD =-0.16,95% CI (-0.29,-0.03)]. Meta-regression analysis of the single covariates showed that the proportion of women, age, and androgen receptor blocking were related to the heterogeneity of the study, and the type of troponin, diabetes, hypertension, and hyperlipidemia did not have an impact on the heterogeneity. Drug use during anesthesia maintenance: inhalation anesthetic group: SMD =-0.40,95% CI (-0.66,-0.14), inhalation anesthetic compound propofol group: SMD =-0.04,95% CI (-0.20, 0.12), propofol group: SMD =-0.29,95% CI (-0.87, 0.30). The difference of post-operative outcome (ICU time, time of ventilation, use of cardiotonic, atrial fibrillation, and hospital stay) was not statistically significant. Conclusion The combined use of RIPC and inhaled anesthetics can reduce the peak of cardiac troponin release after cardiovascular surgery, but has no significant effect on postoperative outcome.
【作者单位】：江苏大学附属人民医院麻醉科;
【分类号】：R614

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