ObjectiveTo systematically review the efficacy and safety of prophylactic use of intra-aortic balloon pump counterpulsation (IABP) before coronary artery bypass grafting (CABG) in high risk patients. MethodsDatabases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to July 2014, to collect randomized controlled trials (RCTs) and cohort studies about prophylactic use of IABP before CABG in high risk patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 6 RCTs and 6 cohort studies involving 1 359 patients were included, of which 633 prophylactically used IABP before CABG (the IABP group) and 736 didn't prophylactically use IABP before CABG (the control group). The results of meta-analysis showed that: compared with the control group, prophylactic use of IABP could significantly reduce perioperative mortality (RCT: OR=0.15, 95%CI 0.06 to 0.38, P<0.000 1; cohort study: OR=0.36, 95%CI 0.19 to 0.67, P=0.001) and postoperative LCOS (RCT: OR=0.23, 95%CI 0.12 to 0.43, P<0.000 01; cohort study: OR=0.21, 95%CI 0.10 to 0.43, P<0.000 1); there was no significant difference between two groups in incidence rate of postoperative myocardial infarction (MI) (RCT: OR=0.34, 95%CI 0.10 to 1.11, P=0.07; cohort study: OR=0.56, 95%CI 0.26 to 1.24, P=0.15); the results of combined analyses of RCTs showed that, prophylactic use of IABP could significantly reduce postoperative ICU stay (MD=-42.94, 95%CI -56.11 to -29.76, P<0.000 01) and postoperative hospital stay (MD=-3.83, 95%CI-5.82 to -1.85, P=0.0002), but these differences were not found in the results of combined analyses of cohort studies (MD=-4.68, 95%CI 20.69 to 11.33, P=0.57; MD=-0.77, 95%CI -1.80 to 0.26, P=0.14). ConclusionProphylactic use of IABP before CABG in high risk patients can significantly reduce the perioperative mortality, postoperative LCOS and the length of ICU stay, however it cannot reduce postoperative MI. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high quality studies.
目的总结常温体外循环下经肺动脉内补片修补术治疗成人粗大型动脉导管未闭（patent ductusarteriosus，PDA）的临床经验。 方法回顾性分析新疆医科大学第一附属医院收治的62例直径大于15 mm PDA患者的临床资料，其中男45例、女17例，年龄18～35岁；常温体外循环辅助下经肺动脉前壁切开，用Foley气囊导管堵住PDA开口直视下行补片修补术，合并其它心内畸形的同期进行矫正。 结果全组病例无早期死亡，术中体外循环时间（40.78±11.03）min，住院时间（12.55±8.41）d。通过电话及门诊随访56例，失访6例，失访率9.68%，随访时间2～18（11±5）个月，无1例死亡，复查心脏超声未见残余分流。术后出现低心排血量综合征2例、不同程度的高血压8例，经积极治疗后均痊愈出院。 结论经肺动脉内补片修补术治疗成人粗大型动脉导管未闭，手术操作简单、风险小、效果良好。
ObjectiveTo systematically review the effectiveness and safety of aspirin-clopidogrel combined anti-platelet therapy after coronary artery bypass grafting (CABG). MethodsDatabases including The Cochrane Library (Issue 2, 2013), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to September 2013 for randomized controlled trials (RCTs) about aspirin-clopidogrel combined anti-platelet therapy after CABG. Two reviewers selected literature independently according to the inclusion and exclusion criteria. After data extraction and methological quality assessment of the included studies, meta-analysis was performed using RevMan 5.2 software. ResultsA total of six RCTs involving 901 patients were included, of which 449 cases were in the aspirin-clopidogrel group (A+C) and 452 cases were in the aspirin with or without placebo group (A+P). The results of meta-analysis showed that: compared with A+P, A+C significantly reduced occlusion rates of the saphenous vein graft (RR=0.59, 95% CI 0.43 to 0.80, P=0.000 6). But no significant difference was found between the two groups in occlusion rates of the left internal mammary artery graft (RR=0.88, 95% CI 0.35 to 2.18, P=0.78), radial artery graft (RR=0.43, 95% CI 0.13 to 1.46, P=0.18), pleural fluid drainage volume (MD=-1.68, 95%CI-48.69 to 45.32, P=0.94), incidence of major bleeding events (RR=1.20, 95% CI 0.39 to 1.65, P=0.75), major cardiovascular events (OR=0.81, 95% CI 0.38 to 1.72, P=0.58), and mortality within 30 days (RR=0.64, 95% CI 0.17 to 2.44, P=0.52). ConclusionIn reducing occlusion rates of the saphenous vein graft, the A+C group is more effective than the A+P group. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.