甲状腺素对体外循环下冠脉搭桥术患者心功能及预后影响的Meta分析(1)
摘要：目的 通过Meta分析探讨甲状腺素对体外循环下冠脉搭桥术后患者心功能及预后的影响，从而指导临床用药。方法 检索pubmed、万方数据库收录的从数据库建库以来一直到2015年10月有关甲状腺素治疗体外循环下冠脉搭桥术的随机对照研究，采用Revman 5.3软件对纳入研究结果进行Meta分析。结果 共纳入了5个研究，心率(HR)、平均动脉压(MAP)、心指数(CI)、外周循环阻力(SVR)，术后房颤发生率(AF)，术后呼吸系统、神经系统并发症、术后感染、死亡率的效应合并量(95%可信区间)分别为：1.43(-0.08～2.95)、-1.20(-2.83～0.44)、0.1495(0.07～0.22)、-116.58(-186.33～-46.82)、0.56(0.33～0.96)、0.58(0.23～1.47)、1(0.19～5.13)、0.55(0.20～1.46)、0.83(0.23～2.99)。结论 在行体外循环下冠脉搭桥术中予补充T3可更加显著的低外周循环阻力及提高心输出量，同时可以降低术后房颤的发生，对于其他并发症以及死亡率未见明显的改善。
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关键词：甲状腺素；体外循环；冠脉搭桥；Meta分析
Meta Analysis of the Effect of Thyroxine on Cardiac Function and Prognosis in Patients Undergoing Coronary Artery Bypass Grafting
XU Hai-long1，WU Liang1，QI Dun-yi2
(1.Jiangsu Provincial Key Laboratory of Anesthesia and Analgesia，Key Laboratory of Anesthesiology， Xuzhou Medical College of Jiangsu Province，Xuzhou 221004，Jiangsu，China；2.Department of Anesthesiology，Affiliated Hospital of Xuzhou Medical College，Xuzhou 221004，Jiangsu，China)
, 百拇医药
Abstract：Objective Discuss the influence of triiodothryonine(T3) on patients's cardiac function and prognosis With on-pump Coronary Artery Bypass Grafting(CCAB) through meta-analysis，guiding clinical medicaion.Methods The randomized cintrolled trials of CCAB with T3 treatment from 1990 to 2010 were searched.And collecting relevant data was Meta analyzed using RevMan 5.3 statistical software.Results A total of 5 documents were included in this study，including 314 cases in the T3 group and 326 cases in the normal saline(NS) group.The pooled effect sizes(95% CI) of heart rate(HR)、mean arterial Pressure(MAP)、cardiac index(CI)，Systemic vascular resistance(SVR)、atrial fibrillation(AF)，Complication of pulmonary，Neurologic，Infection and mortality were 1.43(-0.08～2.95)，-1.20(-2.83～0.44)，0.14 95(0.07～0.22)-116.58(-186.33～-46.82)0.56(0.33 0.96)，0.58(0.23～1.47)，1(0.19～5.13)，0.55(0.20～1.46)，0.83(0.23～2.99). Conclusion This meta-analysis demonstrates that T3 treatment during CCAB can raises cardiac output and lowers SVR，reducing the incidence of AF，other complications and mortality did not see obvious improvement.
, http://www.100md.com
Key words：Triiodothryonine；Cardiopulmonary bypass；Coronary artery bypass graft；Meta-analysis
甲狀腺素是上世纪初就成功分离和确定结构的激素之一，其通过影响心肌收缩力、心电节律和血管舒缩能力在心脏发挥重要作用[1]，而体外循环后患者体内T3水平会出现明显的下降[2]，这可能与CPB低温、低血容量、血液稀释以及炎性介质激活有关[3-4]，有研究显示在心脏手围术期予补充甲状腺素可以明显改善心功能及手术预后[5-7]，本文旨在通过分析补充T3对体外循环下冠脉搭桥术围术期血流动力学以及预后的影响，探讨甲状腺素治疗的可行性。
1 资料与方法
1.1一般资料 笔者系统性的检索了pubmed、万方数据库，检索语言为中文及英文，检索时间从数据库建库以来一直到2015年10月，中文检索词为甲状腺素、三碘甲腺原氨酸、T3、体外循环、CABG、冠脉搭桥，英文检索词包括：thyroxine、triiodothyronine、CPB、Cardiopulmonary bypass、CABG等。, 百拇医药(徐海龙 吴靓 齐敦益)
, http://www.100md.com
关键词：甲状腺素；体外循环；冠脉搭桥；Meta分析
Meta Analysis of the Effect of Thyroxine on Cardiac Function and Prognosis in Patients Undergoing Coronary Artery Bypass Grafting
XU Hai-long1，WU Liang1，QI Dun-yi2
(1.Jiangsu Provincial Key Laboratory of Anesthesia and Analgesia，Key Laboratory of Anesthesiology， Xuzhou Medical College of Jiangsu Province，Xuzhou 221004，Jiangsu，China；2.Department of Anesthesiology，Affiliated Hospital of Xuzhou Medical College，Xuzhou 221004，Jiangsu，China)
, 百拇医药
Abstract：Objective Discuss the influence of triiodothryonine(T3) on patients's cardiac function and prognosis With on-pump Coronary Artery Bypass Grafting(CCAB) through meta-analysis，guiding clinical medicaion.Methods The randomized cintrolled trials of CCAB with T3 treatment from 1990 to 2010 were searched.And collecting relevant data was Meta analyzed using RevMan 5.3 statistical software.Results A total of 5 documents were included in this study，including 314 cases in the T3 group and 326 cases in the normal saline(NS) group.The pooled effect sizes(95% CI) of heart rate(HR)、mean arterial Pressure(MAP)、cardiac index(CI)，Systemic vascular resistance(SVR)、atrial fibrillation(AF)，Complication of pulmonary，Neurologic，Infection and mortality were 1.43(-0.08～2.95)，-1.20(-2.83～0.44)，0.14 95(0.07～0.22)-116.58(-186.33～-46.82)0.56(0.33 0.96)，0.58(0.23～1.47)，1(0.19～5.13)，0.55(0.20～1.46)，0.83(0.23～2.99). Conclusion This meta-analysis demonstrates that T3 treatment during CCAB can raises cardiac output and lowers SVR，reducing the incidence of AF，other complications and mortality did not see obvious improvement.
, http://www.100md.com
Key words：Triiodothryonine；Cardiopulmonary bypass；Coronary artery bypass graft；Meta-analysis
甲狀腺素是上世纪初就成功分离和确定结构的激素之一，其通过影响心肌收缩力、心电节律和血管舒缩能力在心脏发挥重要作用[1]，而体外循环后患者体内T3水平会出现明显的下降[2]，这可能与CPB低温、低血容量、血液稀释以及炎性介质激活有关[3-4]，有研究显示在心脏手围术期予补充甲状腺素可以明显改善心功能及手术预后[5-7]，本文旨在通过分析补充T3对体外循环下冠脉搭桥术围术期血流动力学以及预后的影响，探讨甲状腺素治疗的可行性。
1 资料与方法
1.1一般资料 笔者系统性的检索了pubmed、万方数据库，检索语言为中文及英文，检索时间从数据库建库以来一直到2015年10月，中文检索词为甲状腺素、三碘甲腺原氨酸、T3、体外循环、CABG、冠脉搭桥，英文检索词包括：thyroxine、triiodothyronine、CPB、Cardiopulmonary bypass、CABG等。, 百拇医药(徐海龙 吴靓 齐敦益)