左西孟旦分析修改2.rm5

摘要：目的： 在本荟萃分析中，比较 IABP 和左西孟旦在冠状动脉旁路移植术 （CABG） 中的临床疗效和安全性。方法：我们在 PubMed、Embase、Cochrane 临床试验数据库和 Google Scholar 中仔细检索了从数据库开始到 2023 年 1 月在患有 CABG 的成年患者中使用左西孟旦和 IABP 支持的临床试验。心房颤动 （AF） 、术后纵隔炎、正性肌力支持需求、院内死亡率、术后重症监护病房 （ICU） 住院时间、术后住院时间、通气时间和平均动脉压 （MAP） 水平是本荟萃分析的主要结局。使用 RevMan 5.4 程序进行荟萃分析，并使用漏斗图分析检查发表偏倚。结果： 最终分析纳入 11 篇文章，共 769 例患者，其中 IABP 组 380 例，左西孟旦组 389 例。与 IABP 相比，左西孟旦在术后 ICU 住院时间、术后住院时间和平均脉搏压降低方面为 CABG 患者提供了显著优势，效应量为 （MD = - 0.83,95% CI：- 0.98 至 -0.69，P < 0.00001）、（MD = - 1.14,95% CI：- 1.33 至 -0.95，P < 0.00001）和 （MD = - 4.45， 95% CI： - 5.94 至 - 2.00，P < 0.00001）。亚组分析显示不同亚组之间的结局存在差异。左西孟旦组 ICU 住院时间的效应量分别为 （MD = - 0.91,95% CI： - 1.06 至 - 0.75，P < 0.00001） 和 （MD = - 0.89,95% CI： - 1.04 至 - 0.74，P < 0.00001） 在随机对照试验 （RCT） 的亚组中< 60 岁。就术后住院时间而言，≥ 60 岁亚组中左西孟旦组的效应量为 （MD = - 2.50,95% CI： - 2.84 至 - 2.17，P < 0.00001）。在 AF 发病率中，左西孟旦组可能在 60 ≥ 岁亚组中具有优势 （RR = 0.33,95% CI： 0.15 至 0.75，P = 0.008）。结论： 在 CABG 患者中，左西孟旦在术后 ICU 住院时间、术后住院时间和 MAP 水平方面优于 IABP。

Abstract: Objective: To compare the clinical efficacy and safety of intra-aortic balloon pump (IABP) and levosimendan in adult patients undergoing coronary artery bypass grafting (CABG) in this meta-analysis. Methods: We systematically searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar from their inception to January 2023 for clinical trials evaluating the use of levosimendan and IABP support in adult patients undergoing CABG. Atrial fibrillation (AF), postoperative mediastinitis, requirement for positive inotropic support, in-hospital mortality, postoperative intensive care unit (ICU) length of stay, postoperative hospital length of stay, mechanical ventilation time, and mean arterial pressure (MAP) were the primary outcomes of this meta-analysis. Meta-analysis was performed using RevMan 5.4 software, and publication bias was examined via funnel plot analysis. Results: A total of 11 articles involving 769 patients were included in the final analysis, with 380 patients in the IABP group and 389 in the levosimendan group. Compared with IABP, levosimendan provided significant benefits for CABG patients in terms of postoperative ICU length of stay, postoperative hospital length of stay, and reduction in mean arterial pressure, with effect sizes of (MD = -0.83, 95% CI: -0.98 to -0.69, P < 0.00001), (MD = -1.14, 95% CI: -1.33 to -0.95, P < 0.00001), and (MD = -4.45, 95% CI: -5.94 to -2.00, P < 0.00001), respectively. Subgroup analysis revealed differences in outcomes across subgroups. In the randomized controlled trial (RCT) subgroup of patients aged <60 years, the effect sizes of the levosimendan group for postoperative ICU length of stay were (MD = -0.91, 95% CI: -1.06 to -0.75, P < 0.00001) and (MD = -0.89, 95% CI: -1.04 to -0.74, P < 0.00001), respectively. For postoperative hospital length of stay, the effect size of the levosimendan group in the ≥60 years subgroup was (MD = -2.50, 95% CI: -2.84 to -2.17, P < 0.00001). Regarding the incidence of AF, the levosimendan group may have advantages in the ≥60 years subgroup (RR = 0.33, 95% CI: 0.15 to 0.75, P = 0.008). Conclusion: In patients undergoing CABG, levosimendan is superior to IABP in terms of postoperative ICU length of stay, postoperative hospital length of stay, and mean arterial pressure levels.