白天变化的影响心脏手术患者的短期结果:符合PRISMA的系统性审查和元分析
Yun-Tai Yao1, Shuo Huang2, Mark Chao3
1Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking; Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China; Center of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston, TX; Outcomes Research Consortium, Houston, TX.
选择性心脏手术的时间,无论是早上还是下午,都不会显著影响患者的死亡率或重大并发症. 然而,早晨的手术显示,新发性心房的发病率略高.
科学领域:
- 心血管生理学和外科手术应激反应.
- 时代生物学及其对医疗结果的影响.
背景情况:
- 已知循环节律会影响生理过程,包括心血管功能和应激反应.
- 心脏外科手术时间对患者结果的潜在影响仍然不清楚,因为之前的研究存在矛盾.
研究的目的:
- 系统地评估心脏手术时间 (早上与下午) 对短期外科术后结果的影响.
- 为了比较上午和下午的选择性心脏手术之间的住院死亡率和主要发病率.
主要方法:
- 对观察性队列研究进行了元分析.
- 包括的患者在心血管中心接受了选择性心脏手术.
- 评估的结果包括死亡率,新发性心房动,心肌梗塞,中风,脏和感染性并发症,重新探索,机械循环支持和康复情况.
主要成果:
- 对135,672名患者的分析显示,在上午和下午手术组之间,住院死亡率没有显著差异.
- 心肌梗塞,中风,脏/传染病并发症,重新探索和机械循环支持的发生率相似.
- 晨间手术与新发性心房的发生率略高相关;然而,呼吸持续时间和停留时间等恢复指标相似.
结论:
- 对选择性心脏手术结果的循环时间影响似乎有限.
- 建议进行进一步的多中心前性研究,以澄清手术时间的作用,特别是在高风险患者群体中.
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