体外与非体外循环冠状动脉旁路移植术再血管化率的系统评价

目的：系统评价采用体外循环与非体外循环下冠状动脉旁路移植术比较,治疗冠状动脉粥样硬化性心脏病的再血管化率。方法：计算机检索MEDLINE（1966～2010.3）、EMbase（1984～2010.3）、Cochrane临床对照试验资料库（2010年第2期）和中国生物医学文献数据库（1979～2010.3）,同时手工检索所有纳入试验的参考文献,质量评价后用RevMan 5.0软件进行Meta分析。结果：共纳入2个随机对照试验,包括2276例患者。Meta分析结果显示：体外循环组的再血管化率高于单用非体外循环组,其差异有统计学意义P〈0.00001[OR=1.78,95%C（I1.40,2.26）]。结论：当前的证据表明,体外循环下冠状动脉旁路移植术在治疗冠心病时,再血管化率比非体外循环高;评价患者长期预后有一定指导意义。由于纳入研究随访时间较短,上述结论尚需要高质量、大样本、长时间的随机双盲对照试验进一步证实。

Evaluation of Revascularization between Off-pump and On-pump Coronary Artery Bypass

Objective： To evaluate the completeness of revascularization about off-pump versus on-pump coronary artery bypass in patients with coronary heart disease.Methods： Randomized controlled trials（RCTs） were identified from MEDLINE（1966 to March 2010）,EMbase（1984 to March 2010）,The Cochrane Library（issue2,2010） and CBM-disc（1979 to March 2010）.Data were extracted with designed criterion and evaluated with Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 by two reviewers indepen-dently.The Cochrane Collaboration＇s RevMan 5.0 software was used for data analyses.Results： Two RCTs involving 2276 patients were included.Two studies showed that the completeness of revascularization in on-pump group was significantly higher than that in the off-pump group（P 0.00001） [OR = 1.78,95% CI（1.40,2.26）].Conclusion： The current evidences indicated that the completeness of revascularization in on-pump group was higher than the off-pump group;which was useful to evaluate the long-term prognosis of patients.But the studies we inclued had a short follow-up time,More trials of high quality are required.