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体外循环对心脏手术患者血栓弹力图指标影响的Meta分析

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目的 系统评价体外循环对心脏手术患者血栓弹力图指标的影响。方法 计算机检索
PubMed、The Cochrane Library、Ovid、Embase、中国生物医学文献数据库和中国知网,搜集具有心脏手
术患者体外循环前后血栓弹力图各指标值的相关文献,检索时限均从建库至2018年7月31日。由2位研
究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3及Stata14软件进行Meta分
析。结果 共有10项回顾性研究符合纳入标准,其中共342例患者纳入最终分析。汇总分析显示,体外循
环前后血小板(MA)受损最严重(SMD=-0.88,95%CI:-1.10~-0.65,P<0.00001),凝血因子(R)
受损亦严重(SMD=0.74,95%CI:0.33~1.16,P=0.0005),纤维蛋白原(K、Angle)受损最小(K:
SMD=0.61,95%CI:0.38~0.85,P<0.00001;Angle:SMD=-0.41,95%CI:-0.59~-0.23,P<0.0001)。
结论 体外循环对心脏手术中患者凝血功能的损害以血小板为首,凝血因子次之,纤维蛋白原最轻;血
栓弹力图指标中R值误差来源较多,其参考价值最小;其余三项参考价值差异不大,但同为代表纤维蛋
白原的K值与Angle值相比较而言,Angle值参考价值更大。

Abstract:

Objective To systematic evaluate of the effect of cardiopulmonary bypass on thromboelastogram
indicators in patients undergoing cardiac surgery. Methods Databases including PubMed, The Cochrane Library,
Ovid, Embase, China Biology Medicine disc, and China National Knowledge Infrastructure were searched to collect
pertinent studies about the outcome of thromboelastogram before and after cardiopulmonary bypass in patients
undergoing cardiac surgery from inception to July 31th 2018. Two reviewers independently screened literature,
extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3
and Stata 14 software. Result Ten retrospective studies met the inclusion criteria and 342 patients were included in
the final analysis. Pooled analysis showed that platelet (MA) damage is most severe before and after cardiopulmonary
bypass (SMD=-0.88, 95%CI: -1.10~-0.65, P<0.00001). Clotting factor (R) damage is also serious (SMD=0.74,
95%CI: 0.33~1.16, P=0.0005). Fibrinogen (K and Angle) damage is minimal (K: SMD=0.61, 95%CI: 0.38~0.85,
P<0.00001; Angle: SMD=-0.41, 95%CI: -0.59~-0.23, P<0.0001). Conclusions This meta-analysis shows that
cardiopulmonary bypass caused great damage to the coagulation function of patients undergoing cardiac surgery, in
which platelets ranked first, coagulation factors took second place, and fibrinogen was the last. The measurement
error of R is large and the reference value is the smallest. The reference value of the other three items was not
different. Both K and Angle represent fibrinogen, but Angle is more valuable than K.

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