含血停搏液与晶体停搏液对未成熟心肌保护作用的Meta分析

The Protection of Blood Cardioplegia and Crystalloid Cardioplegia on Myocardial of Immature: A Meta-Analysis

摘要: 目的：比较含血停搏液与晶体停搏液对未成熟心肌的保护作用。方法：中国期刊全文数据库、中文科技期刊全文数据库，检索时间从各数据库建库至2010年12月；同时辅助其他检索，纳入比较含血停搏液与晶体停搏液对未成熟心肌的保护的随机对照试验(RCTs)。两名评价者独立评价纳入研究的质量并提取资料，并用RevMan 5.0软件进行统计分析。结果：共纳入9篇RCTs共计340例患者。Meta分析结果显示：含血停搏液与晶体停搏液相比，在正性肌力药物依赖性(OR = 0.30, 95%CI(0.12, 0.8), P = 0.01)；在心肌肌钙蛋白I术毕(MD = −35.98, 95%CI(−57.69, −14.27), P = 0.001)；在心肌肌钙蛋白I术后24 h(MD = −16.97, 95%CI(−26.80, −7.14), P = 0.0007)；在肌酸激酶同工酶术毕(MD = −3.61, 95%CI(−5.00, −2.21), P < 0.00001)；在肌酸激酶同工酶术后24 h(MD = −12.77, 95%CI(−23.26, −2.27), P = 0.02)；在肌酸激酶同工酶术后48 h(MD = −4.97, 95%CI(−9.38, −0.57), P = 0.03)方面的差异有统计学意义。在心脏自动复跳率(OR = 0.73, 95%CI(0.26, 2.08), P = 0.56)；在心肌肌钙蛋白I术后48 h(MD = −2.06, 95%CI(−4.20, 0.08), P = 0.06)方面的差异无统计学意义。结论：含血停搏液对未成熟心肌具有显著的保护，但鉴于纳入研究质量不高，仍需大样本多中心随机对照临床试验进一步证实其临床疗效。

Abstract: Objective: To compare the protection between blood cardioplegia and crystalloid cardioplegia on immature myocardial. Methods: We searched Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Da- tabase, and Chinese Journal Full-text Database up to December 2010 to identify randomized controlled trials (RCTs)comparing blood cardioplegia and crystalloid cardioplegia for immature myocardial. We evaluated the quality of the included studies and analyzed data by Cochrane Collaboration’s RevMan 5.0 software. Results: Nine RCTs involving 340 patients were included. The results of meta analysis suggested that there were significant differences between blood cardioplegia and crystalloid cardioplegia the dependence degrees of positive inotropic after operation in systolic (OR = 0.30, 95%CI (0.12, 0.8), P = 0.01), Serum troponin-I after operation (MD = −16.97, 95%CI (−26.80, −7.14), P = 0.0007), Serum troponin-I 24 hours after operation (MD = −16.97, 95%CI (−26.80, −7.14), P = 0.0007), MB isoenzyme of creatine kinase (CK-MB) after operation (MD = −3.61, 95%CI (−5.00, −2.21), P < 0.00001), MB isoenzyme of creatine kinase (CK-MB) 24 hours after operation (MD = −12.77, 95%CI (−23.26, −2.27), P = 0.02), MB isoenzyme of creatine kinase (CK-MB) 48 hours after operation (MD = −4.97, 95%CI (−9.38, −0.57), P = 0.03) There were not dif- ferences between blood cardioplegia and crystalloid cardioplegia automatic re-jump rate (OR = 0.73, 95%CI (0.26, 2.08), P = 0.56); Serum troponin-I 48 hours after operation (MD = −2.06, 95%CI (−4.20, 0.08), P = 0.06). Conclusion: The results of meta-analysis indicate that blood cardioplegia have significant effects in protection on immature myocar- dial, but due to the limitation of sample sight, and the quality of original studies, the effects of blood cardioplegia on immature myocardial need to be confirmed by large multi-center randomized controlled trials.