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的影响

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目的 评价不接触技术与传统技术在冠状动脉旁路移植术术后血管通畅度中的差异。 方法 检索自 1997 年 1 月至 2017 年 11 月发表在 Pubmed、Cochrane Library、中国期刊全文数据库、万方数据库等的有关不接触技术同传统技术对比的相关文献。采用 Jadad 评分进行质量验证。应用 Revman5.0 软件进行 Meta 分析。 结果 共纳入 6 个研究,均为随机对照研究,Jadad 评分均为 5 分。Meta 分析结果显示,两组术后死亡(1 月内)差异无统计学意义[OR=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[OR=1.46,95%CI(0.23,9.16),P=0.68]。两组短期心源性死亡(12~18 月)差异无统计学意义[OR=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[OR=0.36,95%CI(0.16,0.79),P=0.01]。不接触技术组短期(12~18 月)随访通畅率较传统技术组更高,且差异有统计学意义[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,且差异具有统计学意义[MD=3.08,95%CI(1.58,5.99),P<0.01]。 结论 在冠状动脉旁路移植术手术中,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,可以提高患者冠脉桥血管的短期、长期通畅率。

Objective To analysis the efficacy of no-touch technique and traditional technique in drawing great saphenous vein during coronary artery bypass grafting. Method Searching the researches were published in Pubmed, Cochrane Library, Chinese Journal Full-text Database, wanfang database during January 1997 to November 2017.Jadad score was used for quality verification.Revman 5.0 was used for analysis. Results There were included 6 researches.Jadad scale for both 6 randomized controlled trials was 5 points.Meta analysis showed that there was no statistical difference inpostoperative mortality between the two groups [OR=0.68, 95%CI(0.11, 4.11), P=0.67]. There was no statistical difference in leg wounds[OR=1.46, 95%CI(0.23, 9.16), P=0.68]. There was no statistical difference in short-term cardiogenic death[OR=0.33, 95%CI(0.10, 1.03), P=0.06]. The no-touch group’s long-term cardiogenic death were significantly lower than the traditional group[OR=0.36, 95%CI(0.16, 0.79), P=0.01]. Postoperative no-touch group’s short-term patency rate was significantly better than the traditional group[MD=3.08, 95%CI(1.58, 5.99), P<0.01]. The long-term patency rate in no-touch group was also higher than the traditional group[MD=3.08, 95%CI(1.58, 5.99),P<0.01]. Conclusions Compared with traditional group, no-touch group increase 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手术; 不接触技术; meta 分析

Key words: Saphenous vein; Coronary artery bypass graft surgery; Non-touch technique; meta analysis

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