体外与非体外循环下冠状动脉旁路移植术后安全性的研究

发布时间：2018-03-12 19:20

本文选题：冠心病　切入点：体外循环　出处：《浙江大学》2015年博士论文　论文类型：学位论文

【摘要】：目的为研究冠心病患者在分别接受体外与非体外循环下冠状动脉旁路移植术后短期(术后30天内)以及长期(术后6月以上)安全性方面的差异,对国外已发表的相关的随机对照临床研究进行系统评价。方法在PubMed, Embase, Springer, Ovid以及Cochrane等外文主要数据库中搜索2014年七月前发表的相关文献,应用Rev.an5.0软件进行META分析,绘制森林图。选用比值比(odds ratio,OR)作为效应量,并估计可信区间。结果共获得符合标准的研究7项,纳入患者共9128名。结果显示,在术后短期,各项不良事件(死亡：OR=0.90,95%CI:0.69-1.16,P=0.41；心肌梗死：OR=0.95,95%CI:0.79-1.15,P=0.61；脑卒中：OR=0.78,95%CI:0.56-1.07, P=0.12;肾功能衰竭：OR=0.84,95%CI:0.60-1.18,P=0.43;不完全血运重建：OR=1.95,95%CI:0.79-4.85,P=0.15)的发生率无显著差异。而在术后长期,大部分不良事件(死亡：OR=1.02,95%CI:0.86-1.22,P=0.81；心肌梗死：OR=0.86,95%CI:0.70-1.04,P=0.12；脑卒中：OR=089,95%CI:0.67-1.19,P=0.44)的发生率无显著差异。非体外循环组后长期不完全血运重建事件发生率明显高于体外循环组(OR=1.45;95%CI:1.02.2.06,P=0.04)。结论体外与非体外循环下冠状动脉旁路移植术后短期的安全性不存在显著差异。而在长期随访中,非体外循环组的不完全血运重建事件发生率更高。
[Abstract]:Purpose. To study the safety of patients with coronary heart disease (CHD) in the short term (within 30 days after coronary artery bypass grafting) and in the long term (beyond June after operation) after extracorporeal and off-pump coronary artery bypass grafting, respectively. The related randomized controlled clinical studies published abroad were systematically reviewed. Method. The relevant literatures published before July 2014 were searched in the main databases of PubMed, Embase, Springer, Ovid and Cochrane. The META analysis was carried out with Rev.an5.0 software, and the forest map was plotted. The ratio ratio odds ratio was selected as the effect quantity and the confidence interval was estimated. Results. A total of 7 subjects were enrolled in a total of 9128 patients who met the criteria. The results showed that, in a short period of time after surgery, The incidence of adverse events (death: ORO 0.9095 CIW 0.69-1.16 P0.41; Myocardial Infarction: OR0.9595 CI0.79-1.15 P0.61; Stroke: OR0.7895 CI: 0.56-1.07, P0.12; Renal failure: OR0.8495CI0.60-1.18P0.43; incomplete revascularization reconstitution: 1.9595CIPresident -0.785 P0.15) had no significant difference. There was no significant difference in the incidence of most adverse events (death: ORO 1.0295 CI: 0.86-1.22 P0.81; Myocardial Infarction: OR0.8695 CI: 0.70-1.04 P0.12; Stroke: OR089C95CI0.67-1.19P0.44). The incidence of long-term incomplete revascularization in the non-cardiopulmonary bypass group was significantly higher than that in the cardiopulmonary bypass group (OR 1.4595CIW 1.02.2.06P0.04). Conclusion. There was no significant difference in short-term safety between off-pump and cardiopulmonary bypass coronary artery bypass grafting, but the incidence of incomplete revascularization events in off-pump group was higher than that in non-cardiopulmonary bypass group.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R654.2

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