论文部分内容阅读
目的 通过荟萃(Meta)分析,探讨缺血预处理(IP)对肝血流阻断肝切除术后肝功能、并发症及住院天数的影响.方法 计算机检索PUBMED,EMBASE,Cochrane图书馆和重庆维普、中国期刊网、万方数据库,依据纳入和排除标准收集相关随机对照试验(RCT),进行文献筛选、数据提取及质量评价,采用RevMan 4.2.2软件进行Meta分析.结果 纳入8个RCT研究共511例患者,文献质量评价均为B级.Meta分析结果表明:肝血流阻断肝切除术后IP组的ALT峰值(加权均数差=-176.37;95%CI为-320.67～-30.06;P=0.02)及并发症发生率(比值比=0.64;95%CI为0.41～0.98;P=0.04)均低于对照组.但两组术中出血、手术时间、肝血流阻断时间、术后AST峰值、术后总胆红素峰值及住院天数无统计学差异.结论 IP可降低肝血流阻断肝切除术后ALT峰值及并发症的发生率,但其对肝脏缺血/再灌注损伤的保护作用尚缺乏充足的证据.“,”Objective To evaluate the effects of ischemic preconditioning (IP) on liver function,complications and hospital stays after hepatectomy under hepatic vascular exclusion by a recta-analysis.Methods Randomized controlled trials (RCTs) were identified from PUBMED,EMBASE,the Cochrane Library,VIP,CNKI and Wanfang Data according to the inclusion and exclusion criteria.Literature screening,data extraction and quality assessment were made and the recta-analysis was processed by RevMan 4.2.2.Results Eight RCTs involving a total of 511 patients were included.The methodological quality was evaluated and all the trials were in graded B.The meta-analysis revealed that the postoperative ALT peak level (weighted mean difference =-176.37;95% CI:-320.67 ～-30.06;P =0.02) and postoperative complications incidence (odd ratio = 0.64;95 % CI:0.41 ～ 0.98;P = 0.04) were lower in IP group compared with control group,but there were no significant differences in blood loss,operating time,hepatic vascular exclusion time,postoperative AST and total bilirubin peak level,and hospital stays in both groups.Conclusions IP reduces the postoperative ALT peak level and complications incidence after hepatectomy under hepatic vascular exclusion,but there is no sufficient evidence to support that the IP can protect the liver from ischemia/reperfusion injury.