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阻塞性睡眠呼吸暫停患者心臟手術後的結局:比較研究的系統評價和Meta分析


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- 2018年4月03日12時26分
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Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis of Comparative Studies

背景與目的


阻塞性睡眠呼吸暫停(OSA)是心臟手術患者常見的合併症,並可能使患者容易發生術後併發症。本meta分析的目的是明確接受心臟手術的OSA患者發生術後併發症的證據。

方 法

檢索Cochrane系統評價資料庫、Medline、Medline在線、Web of

Science、Scopus、EMBASE、Cochrane對照試驗註冊庫和CINAHL建庫至2016年10月的文獻。檢索接受心臟手術診斷或懷疑OSA的成年患者的研究。所有納入研究必須報告至少1個術後併發症。主要結局是術後30天內主要不良心腦血管事(MACCEs),包括全因死亡、心肌梗死、心肌損傷、非致死性心臟驟停、血管重建、肺栓塞、深靜脈血栓形成、新出現的術後房顫(POAF)、中風和充血性心力衰竭。次要結局是新出現的POAF。其他探索性結局包括:(1)術後氣管插管和機械通氣;

(2)感染和/或敗血症; (3)非計劃重症監護病房(ICU)入院; 和(4)住院和ICU的住院時間。分別使用Cochrane評估管理器5.3(Cochrane,倫敦,英國)和OpenBUGS v3.0進行meta分析和Meta回歸。

結 果


納入了11項比較研究(n = 1801例,OSA與非OSA分別為688例和1113例)。MACCE在OSA患者中的發生率比非OSA高33.3%(OSA vs非OSA:31%:10.6%;比值比:2.4; 95%置信區間,1.38-4.2; P = .002)。與非OSA相比,OSA患者新出現的POAF發生率增高(OSA vs非OSA:31%vs 21%;

OR,1.94; 95%CI,1.13-3.33; P = .02)。儘管OSA患者的術後氣管插管和機械通氣(OSA與非OSA:13%比5.4%; OR,2.67; 95%CI,1.03-6.89; P =

.04)明顯高於非OSA患者,但OSA患者的住院時間和住院時間與非OSA患者相比無明顯差異。大多數OSA患者未經持續氣道正壓通氣治療。亞組的Meta回歸和敏感性分析不影響OSA組和非OSA組術後併發症的OR值。

結 論

Meta分析顯示,在心臟手術後,OSA患者MACCE和新出現的POAF比非OSA患者分別高出33.3%和18.1%

原始文獻摘要

Nagappa M, Ho G, Patra J, et al. Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis of Comparative Studies.

Anesthesia & Analgesia, 2017:1.

BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in patients undergoing cardiac surgery and may predispose patients to postoperative

complications. The purpose of this meta-analysis is to determine the evidence of postoperative complications associated with OSA patients undergoing cardiac surgery.

METHODS: A literature search of Cochrane Database of Systematic Reviews, Medline, Medline In-process, Web of Science, Scopus, EMBASE, Cochrane Central Register

of Controlled Trials, and CINAHL until October 2016 was performed. The search was constrained to studies in adult cardiac surgical patients with diagnosed or suspected OSA. All included studies must

report at least 1 postoperative complication. The primary outcome is major adverse cardiac or cerebrovascular events (MACCEs) up to 30 days after surgery, which includes death from all-cause

mortality, myocardial infarction, myocardial injury, nonfatal cardiac arrest, revascularization process, pulmonary embolism, deep venous thrombosis, newly documented postoperative atrial fibrillation

(POAF), stroke, and congestive heart failure. Secondary outcome is newly documented POAF. The other exploratory outcomes include the following: (1) postoperative tracheal intubation and mechanical


ventilation; (2) infection and/or sepsis; (3) unplanned intensive care unit (ICU) admission; and (4) duration of stay in hospital and ICU. Meta-analysis and meta- regression were conducted using

Cochrane Review Manager 5.3 (Cochrane, London, UK) and OpenBUGS v3.0, respectively.

RESULTS: Eleven comparative studies were included (n = 1801 patients; OSA versus non-OSA: 688 vs 1113, respectively). MACCEs were 33.3% higher odds in OSA

versus non-OSA patients (OSA versus non-OSA: 31% vs 10.6%; odds ratio , 2.4; 95% confidence interval , 1.38–4.2; P = .002). The odds of newly documented POAF (OSA versus non-OSA: 31% vs 21%;

OR, 1.94; 95% CI, 1.13–3.33; P = .02) was higher in OSA compared to non-OSA. Even though the postoperative tracheal intubation and mechanical ventilation (OSA versus non-OSA: 13% vs 5.4%; OR, 2.67;

95% CI, 1.03–6.89; P = .04) were significantly higher in OSA patients, the length of ICU stay and hospital stay were not significantly prolonged in patients with OSA compared to non-OSA. The majority

of OSA patients were not treated with continuous positive airway pressure therapy. Meta-regression and sensitivity analysis of the subgroups did not impact the OR of postoperative complications for

OSA versus non-OSA groups.

CONCLUSIONS: Our meta-analysis demonstrates that after cardiac surgery, MACCEs and newly documented POAF were 33.3% and 18.1% higher odds in OSA versus non-OSA

patients, respectively.

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