背景:主动脉内球囊反搏(IABP)技术在为血流动力学不稳定的患者提供循环支持方面起着至关重要的作用。本研究旨在评估急性临界冠状动脉旁路移植术(CABG)患者术前预防性IABP插入的有效性和安全性。
方法:在PubMed中进行了全面搜索,科克伦图书馆,和Embase数据库,涵盖1995年1月至2022年9月期间。
结果:肾功能不全的发生率,机械通气超过24小时,与对照组相比,IABP组的出血事件无显著差异(相对危险度[RR]=0.85,P=0.26;RR=0.81,P=0.08;RR=0.95,P=0.87).然而,IABP组住院死亡率明显低于对照组(RR=0.54,P=0.0007),IABP组的ICU住院时间较短(平均差异[MD]=-1.12,P<0.000001)。与对照组相比,IABP组的低心输出量综合征(LCOS%)的发生率也较低(RR=0.61,P<0.0001),主要不良心脑血管事件发生率较低(MACCE%)(RR=0.70,P=0.001).在漏斗图分析中没有观察到显著的发表偏倚。
结论:目前认为术前预防性插入IABP有利于改善接受CABG的危重患者的预后。这种技术降低了医院死亡率,缩短ICU停留时间,并降低LCOS%和MACCE%的发生率。
BACKGROUND: The intra-aortic balloon pump (IABP) technique plays a crucial role in providing circulatory support for patients experiencing hemodynamic instability. This study aimed to assess the effectiveness and safety of preoperative prophylactic IABP insertion in patients undergoing acute critical coronary artery bypass grafting (CABG).
METHODS: A comprehensive search was conducted in PubMed, Cochrane Library, and Embase databases, covering the period from January 1995 to September 2022.
RESULTS: The incidence of renal insufficiency, mechanical ventilation exceeding 24 h, and bleeding events in the IABP group did not exhibit significant differences compared to the control group (relative risk [RR] = 0.85, P = 0.26; RR = 0.81, P = 0.08; RR = 0.95, P = 0.87). However, the hospital mortality rate was significantly lower in the IABP group than in the control group (RR = 0.54, P = 0.0007), and the length of ICU stay was shorter in the IABP group (mean difference [MD] = -1.12, P < 0.000001). The IABP group also exhibited a lower incidence of low cardiac output syndrome (LCOS%) compared to the control group (RR = 0.61, P < 0.0001), and a lower incidence of major adverse cardiac and cerebrovascular events (MACCE%) (RR = 0.70, P = 0.001). No significant publication bias was observed in the funnel plot analysis.
CONCLUSIONS: Preoperative prophylactic insertion of IABP is currently considered beneficial in improving outcomes for critically ill patients undergoing CABG. This technique reduces hospital mortality, shortens ICU stays, and lowers the incidence of LCOS% and MACCE%.