天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (1): 95-99.doi: 10.11958/20150295

• 循证医学 • 上一篇    下一篇

非体外循环和体外循环下冠状动脉搭桥术远期并发症比较的 Meta 分析 #br# #br#

汪百川   

  1. 肥西县人民医院
  • 收稿日期:2015-11-09 修回日期:2016-01-30 出版日期:2017-01-15 发布日期:2017-01-15

A meta-analysis of randomized trials for long-term major complications following off-pump versus on-pump coronary artery bypass grafting

  • Received:2015-11-09 Revised:2016-01-30 Published:2017-01-15 Online:2017-01-15

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摘要： 摘要： 目的 比较非体外循环下冠状动脉搭桥术 （OPCABG） 和体外循环下冠状动脉搭桥术 （ONCABG） 的远期并 发症。方法 检索中国知网、 万方、 维普、 PubMed、 EMBASE、 Cochrane 图书馆等数据库， 查找关于 OPCABG 和 ONCABG 的随机对照试验（RCT）文献， 按 Cochrane 系统评价方法， 对纳入的研究文献进行质量评价， 并提取有效数 据后采用 RevMan5.2 软件进行 Meta 分析。结果 共纳入 9 个研究， 11 660 例患者， 其中 OPCABG 组 5 794 例， ONCABG 组 5 866 例。Meta 分析结果显示 2 组远期死亡率接近， 差异无统计学意义（OR=1.10， 95%CI： 0.94,～1.30， P=0.22）； 远期心肌梗死率接近， 差异无统计学意义 （OR=0.90， 95%CI： 0.76～1.06， P=0.21）； ONCABG 的远期血运重建 率低于 OPCABG （OR=1.41， 95%CI： 1.09～1.83， P=0.009）； OPCABG 的远期脑卒中率低于 ONCABG （OR=0.75， 95%CI： 0.57～0.98， P=0.04）。结论 ONCABG 可有效降低患者远期血运重建的发生， 而 OPCABG 可有效降低患者远期脑卒 中的发生。

关键词: 冠状动脉旁路移植术, 非体外循环； 体外循环； 手术后并发症； 死亡率； 心肌梗死； 卒中； Meta 分析； 非体 外循环下冠状动脉搭桥术； 体外循环下冠状动脉搭桥术； 血运重建

Abstract: Abstract: Objective To compare the long- term complications of off- pump and on- pump coronary artery bypass grafting. Methods CNKI, WanFang Data, VIP, PubMed, EMBASE and the Cochrane Central Register were searched for randomized controlled trials (RCTs) of long-term complications of off-pump and on-pump coronary artery bypass grafting. According to the Cochrane system evaluation method, the quality of the research literature was evaluated by the inclusion and exclusion criteria, and the RevMan5.2 software was used for meta analysis. Results A total of 9 studies were included, including 11 660 patients, 5 794 patients in the OPCABG group and 5 866 cases in the ONCABG group. There was no significant difference in mortality between the OPCABG group and the ONCABG group (OR=1.10, 95%CI: 0.94-1.30，P= 0.22] and no significant difference in myocardial infarction (OR =0.90, 95%CI: 0.76-1.06，P=0.21). However, the difference in revascularization was statistically significant between the two groups (OR=1.41, 95%CI: 1.09-1.83，P=0.009). The longterm incidence of stroke was significantly lower in OPCABG group than that of ONCABG group (OR=0.75, 95%CI: 0.57- 0.98，P=0.04]. Conclusion The on-pump coronary artery bypass grafting can effectively reduce the occurrence of longterm revascularization. However, off-pump coronary artery bypass grafting can effectively reduce the risks of stroke.

Key words: coronary artery bypass, off- pump, extracorporeal circulation, postoperative complications, mortality, myocardial infarction, stroke, Meta-analysis, on pump coronary artery bypass grafting, revascularization