文献类型：期刊文献

中文题名：糖皮质激素在体外循环下心脏手术中肺保护作用临床随机对照试验的Meta分析

英文题名：The protective effect of glucocorticoid on lung injury under cardiopulmonary bypass:A Meta-analysis

作者：单文斌[1];刘凯[1];胡继宏[1];靳利梅[1];移康[2]

第一作者：单文斌

机构：[1]甘肃中医药大学,甘肃兰州730000;[2]甘肃省人民医院心血管外科,甘肃兰州730000

第一机构：甘肃中医药大学

年份：2016

卷号：6

期号：9

起止页码：220

中文期刊名：中国医药科学

外文期刊名：China Medicine And Pharmacy

基金：甘肃中医药大学学生科技学术创新基金项目(2014-27)

语种：中文

中文关键词：糖皮质激素;体外循环;心脏手术;随机对照试验;Meta分析;系统评价

外文关键词：Glucocorticoid（GC）; Cardiopulmonary Bypass（CPB）; Cardiac surgery; Randomized controlled trial; Meta-analysis; Systematically review;

摘要：目的系统评价糖皮质激素在体外循环下心脏手术中对肺的保护作用。方法采用Cochrane系统评价方法,计算机检索Cochrane图书馆(2015)、Pub Med(1978-2015.12)、CNKI(1994-2015.12)、Wan Fang(1977-2015.12)数据库,收集所有糖皮质激素在体外循环下心脏手术中肺保护作用的随机对照试验(RCT),试验组使用糖皮质激素,对照组使用生理盐水或为空白对照组。由2位评价者按照纳入和排除标准筛选文献、提取资料并进行方法学质量评价,然后采用Rev Man 5.3软件进行Meta分析。结果共纳入10个RCT,共计707例患者。Meta分析显示:与对照组相比,糖皮质激素可降低治疗组患者的肺泡动脉氧分压差(A-a DO2)[MD=-24.89,95%CI(-39.45,-10.32),P=0.0008],可提高治疗组患者的氧合指数(OI)[MD=10.72,95%CI(0.50,20.94),P=0.04],亚组分析显示糖皮质激素能在气管插管后10min[MD=-8.56,95%CI(-14.52,-2.60),P=0.005]和手术开胸后10min[MD=-11.41,95%CI(-22.56,-0.27),P=0.04]降低治疗组的A-a DO2,在术后12h时提了高治疗组的OI[MD=29.06,95%CI(21.13,36.99),P<0.00001];治疗组患者的呼吸指数(RI)稍低于对照组,但差异无统计学意义[MD=-0.17,95%CI(-0.35,-0.02),P=0.07]。结论体外循环下心脏手术中给予糖皮质激素可减轻患者的肺损伤,起到一定的肺保护作用。
Objective To systematically review the protective effects of glucocorticoid on lung during cardiac surgey with Cardiopulmonary bypass.Methods The literatures of randomized controlled trials （RCTs） about the protective effect of glucocorticoid on lung during cardiac surgey with cardiopulmonary bypass were electronically searched in Cochrane library（2015）, PubMed（from 1978 to December 2015）, CNKI（from 1994 to Decemeber 2015）, WanFang （from 1977 to December 2015）. The intervention was glucocorticoid in the treatment group and physiological saline or blank control in the control group. Articles were identied independently by two reviewers according to the inclusion and exclusion criteria, then extracted the data, and assessed the quality of the included studies, and finally analyzed with RevMan 5.3 software.Results A total of 10 RCTs involving 707 patients met the inclusion critera. The outcomes of meta-analysis indicated that： in the comparison with control group, A- aDO2 was reduced 24.89mm Hg（95%CI：10.32-39.45） and the OI was increased 10.72 mm Hg（95%CI：0.5-20.94） by Glucocorticoid. Glucocorticoid reduced the A-aDO2 [MD=-24.89,95%CI（-39.45,-10.32）,P=0.0008];improved the OI [MD=10.72,95%CI（0.50,20.94）,P=0.04]. In subgroup analysis, A-aDO2 was respectively decreased 8.56 mm Hg（95%CI：2.60-14.52） after tracheal intubation for 10 min, and decreased 11.41mmHg（95%CI：0.27-22.56） after the cardiac thoracic surgey for 10 min, and OI was increased 29.06mmHg（95%CI：0.02-0.35） at 12h after operation by Glucocorticoid. Subgroup analysis showed that Glucocorticoid reduced the A-aDO2 after tracheal intubation for 10 min[MD=-8.56,95%CI（-14.52,-2.60）,P=0.005]and also decreased it after the cardiac thoracic surgey for 10 min[MD=-11.41,95%CI（-22.56,-0.27）,P=0.04]; improved the OI at 12h after operation[MD=29.06,95%CI（21.13,36.99）,P〈0.00001]. The respiratory index（RI） was lower in the treatment group than it in the control group though the difference was not significant[MD=-0.17,95%CI（-0.35,-0.02）,P=0.07].ConclusionGlucocorticoid can reduce the lung injury and protect the lung function during cardiac surgey with cardiopulmonary bypass.