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ATS：双侧乳内动脉移植术的胸骨切口感染风险增加

2013-03-22 猎人VS狼 丁香园

双侧乳内动脉移植术感染
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双侧乳内动脉移植（BIMA）的有利生存结果已经确立。来自上海交通大学医学院附属仁济医院心血管外科的薛松等人进行相应荟萃分析以明确BIMA移植是否会增加胸骨切口感染（SWI）的风险（与单侧乳内动脉移植术（SIMA）相比）。研究结果于2013年2月28日发表于Ann Thorac Surg。结果发现BIMA组的SWI风险较SIMA组高。研究人员由此认为双侧乳内动脉移植术的胸骨切口感染风险增加。 研究


双侧乳内动脉移植（BIMA）的有利生存结果已经确立。来自上海交通大学医学院附属仁济医院心血管外科的薛松等人进行相应荟萃分析以明确BIMA移植是否会增加胸骨切口感染（SWI）的风险（与单侧乳内动脉移植术（SIMA）相比）。研究结果于2013年2月28日发表于Ann Thorac Surg。结果发现BIMA组的SWI风险较SIMA组高。研究人员由此认为双侧乳内动脉移植术的胸骨切口感染风险增加。
研究人员在PubMed，EMBASE和Cochrane对照试验注册中心进行文献检索。对SIMA和BIMA进行比较的观察性研究亦包括在内。感兴趣的结果是SWI风险。并进行文献检索，数据提取和质量评估。在本研究也对敏感性和发表偏倚进行了评估。
研究人员共检索到4701篇文献，最终纳入32篇。该荟萃分析表明，BIMA组的SWI风险较SIMA组高（相对风险[RR]0.62，95％可信区间[CI]为0.55-0.71）。此外，糖尿病患者进行BIMA移植的SWI风险较高（RR0.65，95％CI为0.52-0.81），老年患者亦较高（RR0.45，95％CI为0.33-0.62）。当采用骨架化技术时，BIMA患者的SWI风险只稍高于SIMA患者，但差异无统计学意义（RR0.84，95％CI0.54-1.31）。
研究人员认为，与SIMA移植术相比，BIMA移植的SWI风险增加。该不良事件在糖尿病和老年患者的发生率进一步增大。骨骼化BIMA安全有效，因此应作为推荐方法。

Background
The advantageous survival outcome of bilateral internal mammary artery grafting (BIMA) has been well established. However, this meta-analysis aims to make clear whether BIMA grafting increases the risk of sternal wound infection (SWI) when compared with single internal mammary artery grafting (SIMA).
Methods
A literature search was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The observational studies reporting a comparison between SIMA and BIMA were included. The outcome of interest was the risk of SWI. Literature search, data extraction, and quality assessment were performed. Sensitivity and publication bias were also assessed in this research.
Results
We identified 4,701 titles and included 32 studies finally. The meta-analysis showed that the risk of SWI in the BIMA group was higher (relative risk [RR] 0.62, 95% confidence interval [CI] 0.55 to 0.71) than that in the SIMA group. Moreover, BIMA grafting was also associated with a higher risk of SWI in diabetic patients (RR 0.65, 95% CI 0.52 to 0.81) as well as elderly patients (RR 0.45, 95% CI 0.33 to 0.62). When skeletonization technique was adopted, the risk of SWI in BIMA patients was just a little higher than that in SIMA patients, but the difference did not reach statistical significance (RR 0.84, 95% CI 0.54 to 1.31).
Conclusions
The BIMA grafting increases the risk of SWI when compared with SIMA grafting. This adverse effect further extends to diabetic and elderly patients. As regarding the method of procurement, skeletonized BIMA is safe and effective, thus it should be the procedure recommended.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1998863, encodeId=d099199886349, content=<a href='/topic/show?id=8e2ee5200ee' target=_blank style='color:#2F92EE;'>#移植术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75200, encryptionId=8e2ee5200ee, topicName=移植术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Mon May 27 03:04:00 CST 2013, time=2013-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2068154, encodeId=c91d206815482, content=<a href='/topic/show?id=e94b298327' target=_blank style='color:#2F92EE;'>#ATS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2983, encryptionId=e94b298327, topicName=ATS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Tue Apr 23 20:04:00 CST 2013, time=2013-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522364, encodeId=e4d41522364be, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sun Mar 24 01:04:00 CST 2013, time=2013-03-24, status=1, ipAttribution=)]
    2013-05-27 cy0324

    #移植术#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1998863, encodeId=d099199886349, content=<a href='/topic/show?id=8e2ee5200ee' target=_blank style='color:#2F92EE;'>#移植术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75200, encryptionId=8e2ee5200ee, topicName=移植术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Mon May 27 03:04:00 CST 2013, time=2013-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2068154, encodeId=c91d206815482, content=<a href='/topic/show?id=e94b298327' target=_blank style='color:#2F92EE;'>#ATS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2983, encryptionId=e94b298327, topicName=ATS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Tue Apr 23 20:04:00 CST 2013, time=2013-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522364, encodeId=e4d41522364be, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sun Mar 24 01:04:00 CST 2013, time=2013-03-24, status=1, ipAttribution=)]
    2013-04-23 12499e01m47暂无昵称

    #ATS#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1998863, encodeId=d099199886349, content=<a href='/topic/show?id=8e2ee5200ee' target=_blank style='color:#2F92EE;'>#移植术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75200, encryptionId=8e2ee5200ee, topicName=移植术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=63a4277, createdName=cy0324, createdTime=Mon May 27 03:04:00 CST 2013, time=2013-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2068154, encodeId=c91d206815482, content=<a href='/topic/show?id=e94b298327' target=_blank style='color:#2F92EE;'>#ATS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2983, encryptionId=e94b298327, topicName=ATS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Tue Apr 23 20:04:00 CST 2013, time=2013-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522364, encodeId=e4d41522364be, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Sun Mar 24 01:04:00 CST 2013, time=2013-03-24, status=1, ipAttribution=)]
    2013-03-24 wangbingxhy

    #双侧#

    0