摘要
目的系统评价磷酸肌酸在心脏瓣膜置换术中的心肌保护作用。方法计算机检索Pub Med,科学引文索引(SCI),Embase,VIP,CNKI,CBM和万方数据库,手工检索国内外公开发表的关于磷酸肌酸在心脏瓣膜置换术中心肌保护作用的随机对照试验(RCT),检索时限均为建库至2018年2月。由2位文献评价员独立筛选文献并提取资料,在评价纳入研究的偏倚风险后采用Rev Man 5.2软件对所得数据进行Meta分析。结果最终纳入10个RCT,共464例受试者。Meta分析结果显示:(1)磷酸肌酸组的术中心脏自动复跳率明显高于对照组(RR=1.36,95%CI 1.22~1.52,P<0.000 01);(2)主动脉阻断开放24 h后磷酸肌酸组静脉血中肌酸激酶同工酶水平明显低于对照组(SMD=-2.90,95%CI-5.19^-0.60,P=0.01);(3)主动脉阻断开放24 h后磷酸肌酸组的静脉血中心肌肌钙蛋白I水平明显低于对照组(SMD=-1.49,95%CI-2.02^-0.97,P<0.000 01)。结论磷酸肌酸的使用有利于提高患者心脏复跳率,并能减轻心肌缺血缺氧损伤等相关不良预后的发生。
Objective To evaluate the myocardial protection of creatine phosphocreatine in cardiac valve replacement.Methods The databases such as Pub Med,SCI,Embase,VIP,CNKI,CBM and Wanfang Data were searched to collect randomized controlled trials（ RCT） from the date of their establishment to February 2018. Meanwhile,conference papers,dissertation and references of included studies were also retrieved manually to collect additional studies. Studies were screened,data were extracted,and the methodological quality was assessed by two reviewers independently. Meta-analyses were conducted by using Rev Man 5. 2 software. Results A total of 10 RCTs involving 464 patients were included. The results of meta-analysis showed that：（1）the intraoperative cardiac automatic hopping rate of the creatine phosphate groups was significantly higher than that of the control group（ RR = 1. 36,95% CI 1. 22 ~ 1. 52,P〈0. 000 01）;（2） the content of creatine kinase isoenzyme in venous blood after aorta blocking open 24 h of the creatine phosphate groups was significantly lower than that of the control group（ SMD =-2. 90,95% CI-5. 19--0. 60,P = 0. 01）;（3）the content of cardiac troponin I in venous blood after aorta blocking open 24 h of the creatine phosphate groups was significantly lower than the control group（ SMD =-1. 49,95% CI-2. 02--0. 97,P〈0. 000 01）. Conclusion The use of creatine phosphate is helpful to improve the heart hopping recovery rate of the patients and reduce the incidence of myocardial ischemia and hypoxia.
作者
沈成
王龙
雷鸿
SHEN Cheng;WANG Long;LEI Hong(Department of Anesthesiology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Wuchang University of Technology Information and Engineering School,Wuhan 430223,China)
出处
《医学综述》
2018年第16期3273-3278,共6页
Medical Recapitulate
基金
国家自然科学基金(81772044)
关键词
磷酸肌酸
心脏瓣膜置换术
心肌保护
META分析
Creatine phosphate
Heart valve replacement
Myocardial protection
Meta-analysis
