二氧化碳辅助与常规心接入的安全性:系统性审查和元分析
Beatriz Castello-Branco1, Bruno Wilnes1, Jakub Sroubek2
1Electrophysiology Section, Advanced Arrhythmia Treatment Center, Belo Horizonte, Brazil.
JACC. Clinical electrophysiology
|February 6, 2026
概括
与传统的"干燥"心膜穿刺 (干燥-EPI) 相比,心周二氧化碳灌注 (EpiCO2) 显著减少了手术并发症和无意中心室穿刺,用于诸如心室动脉冲动移除等手术.
科学领域:
- 心血管干预 心血管干预
- 电子生理学 电子生理学
- 最少侵入性手术的方法
背景情况:
- 穿皮上心膜接入对于心室动脉冲动移除至关重要.
- 传统的"干燥"心膜刺穿 (干燥-EPI) 携带与接入有关的并发症的风险.
- 周心二氧化碳吸入 (EpiCO2) 通过改善解剖视觉,提供了一个潜在的更安全的替代方案.
研究的目的:
- 系统地比较EpiCO2与干式EPI的安全性和有效性.
- 评估与每个技术相关的并发症率和程序结果.
主要方法:
- 一个全面的系统审查和对多个数据库的元分析 (PubMed/MEDLINE,Embase,Scopus,科学网络,Cochrane).
- 包括119项研究,涉及8784项手术,主要用于腹腔动脉冲动脉切除.
- 为了评估结果,进行了随机效应元分析,子组分析和元回归.
主要成果:
- 与干式EPI相比,EpiCO2与需要手术的并发症显著减少 (0.24%对1.55%,P<0.010).
- 在EpiCO2与干式EPI (0.28%与3.17%,P<0.010) 相比,无意中腹腔穿刺率明显较低.
- 这些发现无论在干式EPI组中使用的针类型如何,都是正确的.
结论:
- EpiCO2显示,意外腹腔穿刺和手术并发症的风险概况明显较低.
- 这些发现支持EpiCO2在临床上更广泛地被采用,作为皮肤上心膜入口的更安全方法.
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