中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

不接触技术对冠状动脉旁路移植术后血管通畅度影响的系统评价与 Meta 分析

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目的 评价采用不接触技术与传统技术行冠状动脉旁路移植术(CABG)术后血管通畅度的差异。 方法 检索 1997 年 1 月至 2017 年 11 月发表在 PubMed、Cochrane Library、中国期刊全文数据库、万方数据库等有关不接触技术与传统技术对比的相关文献。采用 Jadad 评分进行文献质量评价。应用 RevMan 5.0 软件进行 Meta 分析。 结果 共纳入 6 个随机对照研究,Jadad 评分均为 5 分。Meta 分析结果显示,两组术后死亡(1 个月内)差异无统计学意义[RR=0.68,95%CI(0.11,4.11),P=0.67]。两组术后腿部愈合不良差异无统计学意义[RR=1.46,95%CI(0.23,9.16),P=0.68]。两组短期心源性死亡(12~18 个月)差异无统计学意义[RR=0.33,95%CI(0.10,1.03),P=0.06],长期心源性死亡(6~8 年)差异有统计学意义[RR=0.36,95%CI(0.16,0.79),P=0.01]。不接触技术组短期(12~18 个月)随访通畅率较传统技术组更高,差异有统计学意义[MD=2.64,95%CI(1.81,3.85),P<0.01]。不接触技术组长期(6~8 年)通畅率较传统技术组更高,差异具有统计学意义[MD=3.08,95%CI(1.58,5.99),P<0.01]。 结论 在 CABG 中,不接触技术取材大隐静脉较传统技术相比可以提高长期存活率,可以提高患者冠状动脉桥血管的短期、长期通畅率。

Objective To analyze the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting. Methods We searched the literatures on no-touch technique versus traditional technique in drawing great saphenous vein during coronary artery bypass grafting in PubMed, Cochrane Library, Chinese Journal Full-text Database, Wanfang database between January 1997 and November 2017. Jadad scale was used for quality verification. RevMan 5.0 was used for analysis. Results Six studies were included. Jadad scale for both 6 randomized controlled trials was 5 points. Meta-analysis showed that there was no statistical difference in postoperative mortality between the two groups with RR=0.68 and 95%CI 0.11 to 4.11(P=0.67). There was no statistical difference in leg wounds with RR=1.46 and 95%CI 0.23 to 9.16 (P=0.68). There was no statistical difference in short-term cardiogenic death with RR=0.33, 95%CI 0.10 to 1.03 ( P=0.06). The no-touch group’s long-term cardiogenic death was significantly lower than the traditional group withRR=0.36, 95%CI 0.16 to 0.79(P=0.01). Postoperative no-touch group’s short-term patency rate was significantly better than that of the traditional group with MD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). The long-term patency rate in the no-touch group was also higher than that of the traditional group withMD=3.08 and 95%CI 1.58 to 5.99 (P<0.01). Conclusion Compared with the traditional group, the no-touch group increases postoperative long-term survival rate, short-term and long-term patency rate.

关键词: 大隐静脉; 冠状动脉旁路移植术; 不接触技术; 系统评价/Meta 分析

Key words: Saphenous vein; coronary artery bypass graft; non-touch technique; systematic review/meta-analysis

引用本文: 周小宇, 郭炯, 黄辰, 舒礼良, 徐敬. 不接触技术对冠状动脉旁路移植术后血管通畅度影响的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1032-1037. doi: 10.7507/1007-4848.201712027 复制

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