天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (10): 1114-1121.doi: 10.11958/20180692

• 循证医学 • 上一篇    下一篇

冠状动脉旁路移植术后延长机械通气 危险因素的Meta分析

王子玉 1，傅强 2△，王树英 2，张斌 2，刘君玲 2，孙贺元 2，闫渭清 2   

  1. 基金项目：天津市卫生行业重点攻关项目（15KG121） 作者单位：1天津医科大学（邮编300070）；2天津市第四中心医院外科重症监护室 作者简介：王子玉（1990），男，硕士在读，主要从事重症医学方面研究 △通讯作者 E-mail: 13920864938@163.com
  • 收稿日期:2018-05-02 修回日期:2018-07-26 出版日期:2018-10-15 发布日期:2018-11-09
  • 通讯作者: 王子玉 E-mail:1044892292@qq.com

A meta-analysis of risk factors for prolonged mechanical ventilation following coronary artery bypass grafting

WANG Zi-yu1，FU Qiang2△，WANG Shu-ying2，ZHANG Bin2，LIU Jun-ling2，SUN He-yuan2，YAN Wei-qing2   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Department of Surgical Intensive Medicine, the Fourth Central Hospital of Tianjin △Corresponding Author E-mail: 13920864938@163.com
  • Received:2018-05-02 Revised:2018-07-26 Published:2018-10-15 Online:2018-11-09
  • Contact: Zi-Yu WANG E-mail:1044892292@qq.com

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摘要： 摘要：目的 系统评价冠状动脉旁路移植术后延长机械通气的危险因素。方法 系统检索PubMed、EMBASE、 Cochrane Library、Web of Science、ClinicalTrials.gov、中国知网、万方、维普等数据库，查找关于冠状动脉旁路移植术后 延长机械通气危险因素的病例对照研究或队列研究，按照Cochrane系统评价方法，筛选符合纳入标准的文献，进行 文献质量评价，并提取相关危险因素调整混杂因素后的比值比（OR）及95%CI，采用RevMan 5.3软件进行Meta分析。 结果 7篇文献纳入研究，累计研究对象5 336例，分别研究人口因素：年龄、性别、体质量指数；术前因素：左室射血 分数、慢性阻塞性肺疾病、肾功能不全；术中因素：手术时间；术后因素：再次手术等因素与冠状动脉旁路移植术后延 长机械通气的相关性。Meta分析结果显示：高龄（OR=1.06，95%CI：1.05~1.07）、女性（OR=1.92，95%CI：1.37~2.68）、肾 功能不全（OR=2.35，95%CI：1.41~3.90）、手术时间长（OR=1.50，95%CI：1.22~1.85）、再次手术（OR=9.56，95%CI：3.65~ 25.00）是冠状动脉旁路移植术后延长机械通气的独立危险因素，左室射血分数偏高（OR=0.97，95%CI：0.95~0.99）是 其保护因素。尚没有足够的证据证实高体质量指数（OR=0.95，95%CI：0.68~1.32）、慢性阻塞性肺疾病（OR=3.94， 95%CI：0.68~22.81）与冠状动脉旁路移植术后延长机械通气的发生具有相关性。结论 高龄、女性、术前左室射血分 数偏低、术前肾功能不全、手术时间长、术后再次手术是冠状动脉旁路移植术后延长机械通气的独立危险因素。本 研究为冠状动脉旁路移植术后延长机械通气的预防和风险预测模型的建立提供了理论支持。

关键词: 冠状动脉旁路移植术, 非体外循环, 呼吸, 人工, 危险因素, Meta分析, 延长机械通气

Abstract: Abstract: Objective To systematically evaluate the risk factors of prolonged mechanical ventilation after coronary artery bypass grafting. Methods PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials. gov, CNKI, Wanfang and VIP were systematically searched for case-control studies or cohort studies on factors associated with prolonged mechanical ventilation following coronary artery bypass grafting. According to Cochrane system evaluation method, the quality of the research literatures meeting the inclusion criteria was evaluated. The adjusted odds ratio (OR) and 95%CI were extracted, and the RevMan5.3 software was used for Meta analysis. Results Seven literatures were included in the study, including 5 336 patients. The correlation between prolonged mechanical ventilation following coronary artery bypass grafting and demographic factors was studied, including age, gender, body mass index, preoperative factors (left ventricular ejection fraction, chronic obstructive pulmonary disease and renal dysfunction), intraoperative factors (operative time) and postoperative factor (reoperation). Meta-analysis revealed that older age (OR=1.06, 95%CI: 1.05-1.07), female (OR=1.92, 95%CI: 1.37-2.68), renal dysfunction (OR=2.35, 95%CI: 1.41-3.90), longer operative time (OR=1.50, 95%CI: 1.22-1.85) and reoperation (OR=9.56, 95%CI: 3.65-25.00) were the independent risk factors for prolonged mechanical ventilation after coronary artery bypass grafting, and higher left ventricular ejection fraction (OR=0.97, 95%CI: 0.95-0.99) was the protective factor. There was insufficient evidence to confirm the correlation between body mass index (OR=0.95, 95%CI: 0.68-1.32), chronic obstructive pulmonary disease (OR=3.94, 95%CI: 0.68-22.81) and prolonged mechanical ventilation after coronary artery bypass grafting. Conclusion Results suggest that older age, female, preoperative lower left ventricular ejection fraction, preoperative renal dysfunction, longer operative time and reoperation are the independent risk factors for prolonged mechanical ventilation after coronary artery bypass grafting. This study provides theoretical support for the prevention and risk prediction model of prolong mechanical ventilation after coronary artery bypass grafting.

Key words: coronary artery bypass, off-pump, respiration, artificial, risk factors, Meta-analysis, prolong mechanical ventilation