心脏外科手术中的手术内血吸和急性损伤:系统性审查和元分析
Mariana Merighi Moreira Salles1, Ricardo Ormanes Massoud2, Pedro Lawall de Carvalho3
1Department of Medicine, University of Oeste Paulista, Jau, Brazil.
Journal of cardiothoracic and vascular anesthesia
|December 27, 2025
概括
根据观察数据,心血管手术期间的手术内血吸血 (HA) 可能会减少急性损伤 (AKI),但随机试验未证实对结局的这种益处.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
背景情况:
- 心血管外科手术中的心肺绕道 (CPB) 可以激活炎症和凝血通路,增加急性损伤 (AKI) 的风险.
- 术内外体外细胞因子吸收剂 (血吸吸收,HA) 用于减轻这些炎症反应,但它们对结局的影响尚不确定.
研究的目的:
- 系统地审查和分析AKI的发病率以及接受心血管外科手术的患者进行脏替代疗法 (RRT) 的需要,包括或不包括手术内血吸血 (HA).
主要方法:
- 在PubMed,Embase和Cochrane图书馆进行了全面的文献搜索,寻找观察性研究和随机对照试验 (RCT).
- 研究比较了在CPB电路中集成的手术内HA与标准手术治疗.
- 使用Review Manager (版本5.4) 分析数据,并使用随机效应模型计算风险比率 (RR) 和95%置信区间 (CI).
主要成果:
- 包括17项研究 (7项RCT),涉及1797名患者 (826名HA患者).
- 总体分析表明,HA的AKI发病率较低 (RR,0.66;95%CI,0.49-0.87),主要是由观察数据驱动的.
- 试验试验没有显示AKI的统计显著降低,并且对RRT的需求在各组之间没有显著差异 (RR,0.83;95%CI,0.63-1.11).
结论:
- 在心血管外科手术期间的观察性研究中,手术内血吸血显示出降低AKI发病率的潜力.
- 然而,目前的随机对照试验数据并未证实对结局的因果益处.
- 需要进行更大规模的标准化试验,才能确定HA在心脏手术后对功能功能的有效性.
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