文章摘要
单龄童,肖雨洁,缪晶晶,夏 超,王 俊.高龄患者体外与非体外循环冠状动脉旁路移植术术后房颤、脑卒中以及病死率比较的meta分析[J].南京医科大学学报,2018,(3):399~403,410
高龄患者体外与非体外循环冠状动脉旁路移植术术后房颤、脑卒中以及病死率比较的meta分析
A meta⁃analysis of atrial fibrillation,stroke and case fatality rate in elderly patients under⁃going on⁃pump or off⁃pump coronary artery bypass grafting
投稿时间:2017-02-27  
DOI:10.7655/NYDXBNS20180325
中文关键词: 冠状动脉旁路移植术  高龄  房颤  脑卒中  meta分析
英文关键词: coronary artery bypass grafting  age  atrial fibrillation  stroke  meta⁃analysis
基金项目:江苏省六大人才高峰项目(2014?WSW?008)
作者单位
单龄童 南京医科大学第一临床医学院江苏 南京 210029 
肖雨洁 南京医科大学第一临床医学院江苏 南京 210029 
缪晶晶 南京医科大学第一临床医学院江苏 南京 210029 
夏 超 南京医科大学第一临床医学院江苏 南京 210029 
王 俊 南京医科大学第一附属医院胸外科江苏 南京 210029 
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中文摘要:
      目的:系统评价高龄(年龄≥80岁)患者体外循环冠状动脉旁路移植术(on?pump coronary artery bypass surgery,CCAB)与非体外循环冠状动脉旁路移植术(off?pump coronary artery bypass surgery,OPCAB)术后房颤、脑卒中发生率以及病死率。方法:利用计算机检索MEDLINE、EMBASE、Cochrane Library,并辅助以手动检索会议记录或灰色文献,收集研究高龄患者CCAB与OPCAB术后房颤、脑卒中发生率以及病死率对比的英文文献资料。采用Review Manager 5.3软件进行meta分析。结果:共纳入15篇文献进入meta分析,均为观察性研究,未检索到随机对照研究(randomized controlled studie,RCT)。共纳入3 271例患者,其中CCAB组1 573例(48%)。meta分析结果表明:OPCAB能显著降低患者术后脑卒中发生率(OR=2.77,95%CI:1.65~4.64,P < 0.001)以及病死率(OR=2.08,95%CI:1.52~2.85,P < 0.001),且差异均有统计学意义(P < 0.05)。两组患者术后房颤发生率的差异不具有统计学意义(OR=1.01,95%CI:0.84~1.22,P=0.91)。结论:与CCAB比,OPCAB能明显减低高龄患者术后脑卒中发生率以及病死率,但仍有待于更多更大的随机对照试验以进一步验证。
英文摘要:
      Objective:To evaluate the effect of atrial fibrillation,stroke and case fatality rate in elderly patients(age ≥80 years)undergoing on?pump coronary artery bypass surgery(CCAB)or off?pump coronary artery bypass surgery(OPCAB). Methods:We searched relevant literature in MEDLINE,EMBASE,Cochrane Library. Meanwhile,conference records or gray literature from cardiovascular congresses were collected to compare CCAB and OPCAB for elderly patients. Meta analysis was performed using Review Manager 5.3 software. Results:A total of 15 articles were included in the meta?analysis,all of which were observed,and randomized controlled studies(RCT)were not retrieved. A total of 3 271 patients were enrolled in this meta?analysis,of which 1 573(48%)were CCAB. Meta?analysis showed that the OPCAB significantly reduced the incidence of postoperative patients with stroke(OR = 2.77,95% CI:1.65~1.65,P < 0.001)and case fatality rate(OR = 2.08,95% CI:1.52~1.52,P < 0.001),and the differences were statistically significant(P < 0.05). Two groups of patients with had no significant difference on postoperative incidence of atrial fibrillation(OR = 1.01,95% CI:0.84~0.84,P=0.91). Conclusion:Compared with CCAB,OPCAB can significantly reduce the incidence of postoperative stroke and case fatality rate in elderly patients,but big size randomized controlled trials are needed for further verification.
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