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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。
OBJECTIVE: To systematically evaluate the rate of revascularization in patients with coronary atherosclerotic heart disease by comparing coronary artery bypass grafting under cardiopulmonary bypass with those without cardiopulmonary bypass. Methods: The clinical data of MEDLINE (1966 ~ 2010.3), EMbase (1984 ~ 2010.3), Cochrane Central Register of Controlled Trials (No. 2 of 2010) and Chinese Biomedical Literature Database (1979 ~ 2010.3) were searched by computer. References, quality evaluation using RevMan 5.0 software Meta analysis. Results: Two randomized controlled trials were included, including 2276 patients. The results of Meta analysis showed that the rate of revascularization in the cardiopulmonary bypass group was higher than that in the cardiopulmonary bypass group alone (P <0.00001, OR = 1.78, 95% C (I1.40, 2.26)]. CONCLUSIONS: Current evidence suggests that coronary revascularization under cardiopulmonary bypass may have a higher rate of revascularization than non-cardiopulmonary bypass in the treatment of coronary heart disease and may provide some guidance in the long-term prognosis of patients. Due to the shorter follow-up period included in the study, the above conclusion still needs further confirmation by high-quality, large-scale randomized long-term double-blind controlled trials.