地塞米松预防心脏手术后心房颤动的荟萃分析
Effect of dexamethasone on atrial fibrillation after cardiac surgery:a meta-analysis
目的 系统评价地塞米松预防心脏手术后心房颤动的效果.方法 采用Cochrane 系统评价的方法,计算机检索PubMed(1966-2009.11)、EMBASE(1974-2009.11)、Cochrane Library (2009年第4期)、中国生物医学文献数据库(1978-2009.11)、中国期刊全文数据库(1994-2009.11)、中文科技期刊全文数据库(1989-2009.11)等数据库.收集地塞米松预防心脏手术后心房颤动的随机对照试验,采用Cochrane Reviewer'Handbook 5.0推荐的方法评价纳入研究的质量,对符合纳入标准的研究采用RevMan 5.0软件进行荟萃分析.结果 共纳入4项研究(667例患者),荟萃分析结果显示:与安慰剂相比,地塞米松可以降低心房颤动的发生率(RR=0.6,95%CI:0.40~0.92,P=0.02),但并不能降低术后的病死率(RR=0.79,95%CI:0.28~2.22,P=0.66).结论 现有证据表明,围手术期使用地塞米松可降低患者心脏手术后心房颤动的发生率,不能降低围手术期患者的病死率.但限于纳入研究样本量少,手术种类局限,地塞米松的用药剂量、时间和次数不明确,在一定程度上降低了本系统评价结果的可靠性和全面性,期待今后的临床研究进一步验证.
更多Objective To assess the effect of preoperative dexamethasone on the occurrence of postoperative atrial fibrillation. Methods Random controlled trails were gathered though searches of PubMed (1966-2009.11), EMBASE (1974-2009.11), Cochrane Library (issue 4, 2009), Chinese Biomedical Literature Database (1978-2009. 11), China Journal Fulltext Database (1994-2009. 11), Chinese Scientific Journals Fulltext Database(1989-2009. 11). Two reviewers independently assessed eligibility and quality of trials, then extracted data. Data were synthesized using RevMan5. 0 software provided by the Cochrane Collaboration. Results A total of four randomized controlled trials (667 participants) were included for systematic review. Meta-analysis showed that there were statistical differences between dexamethasone and placebo in postoperative atrial fibrillation (RR =0.6,95%CI:0.40 to 0.92, P=0.02), dexamethasone did not reduce post-operative mortality ( RR = 0. 79, 95% CI:0.28 to 2. 22, P = 0. 66). Conclusions The current evidence shows that dexamethasone could reduce the incidence of atrial fibrillation after cardiac surgery, not decrease mortality. There were few limitations in our study may lead to weaken reliability of the conclusions, such as small simple size, different operation types, or the dosage, time and frequency of dexamethasone were unclear. Its effectiveness was needed to further validate in future clinical studies.
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