糖尿病患者进行冠状动脉旁路移植手术的整体动脉再血管:系统性审查和元分析
Guang-Zhi Liao1, Ting Liu1, Yi-Ming Li1
1Department of Cardiology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China.
Reviews in cardiovascular medicine
|July 30, 2024
概括
整体动脉再血管化 (TAR) 可以改善糖尿病患者的生存率,而不会增加早期风险. 在这个人群中,射线动脉移植显示出希望,作为双边内部乳腺动脉移植的更安全的替代方案.
科学领域:
- 心血管外科心血管外科
- 糖尿病患者的治疗结果
- 动脉移植是一种动脉移植.
背景情况:
- 整体动脉复血管化 (TAR) 越来越受欢迎,但其在糖尿病患者中的安全性和有效性尚不清楚.
- 在接受冠状动脉旁路移植 (CABG) 手术的糖尿病患者中,了解不同动脉导管的结果至关重要.
研究的目的:
- 系统地审查和元分析TAR在糖尿病患者中的安全性和有效性.
- 评估在接受CABG的糖尿病患者中不同动脉部署的临床结果.
主要方法:
- 从PubMed,Embase和Cochrane图书馆对研究进行系统审查和元分析,截至2022年7月.
- 主要结局:任何原因的长期死亡率 (>12个月). 二次结局:心血管死亡,早期胸部伤口感染 (SWI) 和早期死亡 (<30天或住院).
- 计算了95%置信区间 (CI) 的风险比率 (RRs) 和危险比率 (HRs).
主要成果:
- 与传统的石静脉移植相比,TAR与早期死亡率或SWI的增加无关.
- 在糖尿病患者中,TAR显著降低了晚期死亡率 (HR 0.52-0.74) 和心血管死亡率 (HR 0.42).
- 双边内部乳腺动脉 (BIMA) 移植减少了整体和心血管死亡,但增加了糖尿病患者的SWI风险;辐射动脉 (RA) 移植显示出一致的好处.
结论:
- 与SVG相比,TAR可为糖尿病患者提供增强的生存益处,而不会增加早期风险.
- 在糖尿病患者中,双边内部乳腺动脉 (BIMA) 移植带来了感染风险的增加和不确定的长期生存收益.
- 在糖尿病患者中,射线动脉 (RA) 移植可能是一种更安全,同样有效的替代方案,而不是右内乳腺动脉 (RIMA).
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