【罂粟摘要】心脏手术中的体温靶向管理：一项对术后认知结果影响的系统综述和Meta分析

心脏手术中的体温靶向管理：一项对术后认知结果影响的系统综述和Meta分析

贵州医科大学 麻醉与心脏电生理课题组

翻译：佟睿    编辑：张中伟    审校：曹莹

背景   

       患者在心脏手术后认知功能下降较为常见。现有文献对术中影响性因素或保护性因素的作用尚无定论。

方法   

       我们系统地回顾了评估低温或常温体外循环(CPB)患者神经认知延迟恢复(DNR)、术后神经认知障碍(NCD)、卒中和死亡率的研究。我们进一步对年龄、手术类型(冠状动脉旁路移植术[CABG]、瓣膜手术或联合手术)和CPB期间的平均动脉压(MAP)进行了亚组分析，并在计算了单一比例和置信区间(CI)后进行了比例Meta分析。

结果   

         我们的分析显示：在共纳入的58项研究、9609名患者中，4010例患者中有1906例(47.5%)发生了DNR，7160例患者中有2071例(28.9%)发生了NCD。4625名患者中90名(2.0%)发生卒中，7589名患者中174名(2.3%)死亡。所考虑的变量与DNR、NCD、卒中和死亡率之间没有统计学意义的关系。亚组分析中，与常温CPB相比，低温CPB下进行联合手术后的患者NCD发生率较高，在常温CPB下行联合手术后患者的DNR和NCD发生率低于CABG手术。与CPB期间MAP≤50~70 mmHg患者相比，CPB期间MAP>70 mmHg的患者DNR发生率较低。

结论

       体外循环期间的体温、MAP和手术类型与心脏手术中的神经认知障碍、中风和死亡率无关。常温体外循环，尤其是在MAP>70 mmHg的情况下，可以降低心脏手术后神经认知功能下降的风险。

        原始文献来源

          Federico Linassi, Eleonora Maran, Alessandro De Laurenzis, et al. Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes. [J]Br J Anaesth, 128 (1): 11e25 (2022).

       英文原文

Targeted temperature management in cardiac surgery: a systematic review and meta-analysis on postoperative cognitive outcomes

Background 

 Postoperative cognitive decline occurs commonly after cardiac surgery. The available literature is inconclusive on the role of intraoperative causal or protective factors.

Methods 

We systematically reviewed studies evaluating delayed neurocognitive recovery (DNR), postoperative neurocognitive disorder (NCD), stroke, and the mortality rates among patients undergoing hypothermic or normothermic cardiopulmonary bypass (CPB). We further performed a subgroup analysis for age, surgery type (coronary artery bypass grafting [CABG], valve surgery, or combined), and the mean arterial blood pressure (MAP) during CPB, and conducted a proportion meta-analysis after calculation of single proportions and confidence intervals (CIs).

Results 

We included a total of 58 studies with 9609 patients in our analysis. Among these, 1906 of 4010 patients (47.5%) had DNR, and 2071 of 7160 (28.9%) had postoperative NCD. Ninety of 4625 patients (2.0%) had a stroke, and 174 of 7589 (2.3%) died. There was no statistically significant relationship between the considered variables and DNR, NCD, stroke, and mortality. In the subgroup analysis comparing hypothermic with normothermic CPB, we found higher NCD rates after combined surgery; for normothermic CPB cases only, the rates of DNR and NCD were lower after combined surgery compared with CABG surgery. A MAP >70 mmHg compared with MAP=50~70 mmHg during CPB was associated with a lower rate of DNR.

Conclusions 

Temperature, MAP during cardiopulmonary bypass age, and surgery type were not associated with neurocognitive disorders, stroke, and mortality in cardiac surgery. Normothermic cardiopulmonary bypass, particularly when performed with MAP >70 mm Hg, may reduce the risk of postoperative neurocognitive decline after cardiac surgery.

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