系统综述

一项关于深低温停循环与选择性顺行脑灌注的meta分析

Published at: 2014年第1卷第7期

David H. Tian 1 , Benjamin Wan 1 , Paul G. Bannon 2 , Martin Misfeld 3 , Scott A. LeMaire 4 , Teruhisa Kazui 5 , Nicholas T. Kouchoukos 6 , John A. Elefteriades 7 , Joseph E. Bavaria 8 , Joseph S. Coselli 4 , Randall B. Griepp 9 , Friedrich W. Mohr 3 , Aung Oo 10 , Lars G. Svensson 11 , G. Chad Hughes 12 , Malcolm J. Underwood 13 , Edward P. Chen 14 , Thoralf M. Sundt 15 , Tristan D. Yan 2
1 Collaborative Research (CORE) Group, Sydney, Australia
2 Collaborative Research (CORE) Group, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
3 Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
4 Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas, USA; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
5 Cardiovascular Center, Hokkaido Ohno Hospital, Sapporo, Japan
6 Missouri Baptist Medical Center, St Louis, Missouri, USA
7 Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
8 Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
9 Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, USA
10 Liverpool Heart and Chest Hospital, Liverpool, UK
11 Center for Aortic Surgery and Marfan and Connective Tissue Disorder Clinic, the Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland, Ohio, USA
12 Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
13 Division of Cardiothoracic Surgery, Chinese University of Hong Kong, Hong Kong, China
14 Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA
15 Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts, USA

摘要

引言:深低温停循环技术(DHCA)因其能最大限度地减少脑代谢活动,成为目前主动脉弓术中保护神经的最佳方法。当手术需要长时间的循环停止时,选择性顺行灌注(SACP)能够及时补充血流灌注。但SACP存在一定的风险,比如栓塞,低灌注和缺血再灌注损伤等。本文的目的在于比较在主动脉弓手术单独应用DHCA技术和DHCA + SACP技术作为神经保护措施的治疗效果。 方法:通过对六个数据资料库的电子文献搜索截至2013年1月发表的,关于DHCA技术与DHCA + SACP技术的相关研究。由两位评审者单独辨别所有文献、提取数据并进行meta分析。 结果:共9篇文章被纳入meta分析,其中DHCA组包括648名患者,DHCA + SACP组包括370名患者。两组在短期或长期神经系统损伤的发生率上并无显著差异。虽然其体外循环时间较长,但DHCA + SACP技术的术后生存率较高(P=0.008, I2=0%)。排除系统性的分析,仍存在少量的具有差异性的临床结果。 结论:目前的meta分析提示DHCA + SACP组可降低主动脉弓术后死亡率。

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