Modified ultrafiltration in adult patients undergoing cardiac surgery
Modified ultrafiltration in adult patients undergoing cardiac surgery
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DOI：
10.1093/icvts/ivu388
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发表时间：
2015-03-01
影响因子：
--
通讯作者：
Angelini, Gianni D.
中科院分区：
文献类型：
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作者：
Zakkar, Mustafa;Guida, Gustavo;Angelini, Gianni D.
根据结构化方案编写心脏手术中的最佳证据主题。讨论的问题是改良超滤对接受心脏手术的成人患者在炎症和代谢变化、失血和早期临床结局方面的影响。使用如下所述的检索共识别出155篇论文。其中，6篇论文提供了回答临床问题的最佳证据，因为它们报告了数据以得出关于本综述关注问题的结论。将作者、发表日期和国家、患者组、研究类型和弱点以及相关结局制成表格。在接受心脏手术的成人患者中，改良超滤似乎可以降低与手术相关的炎症分子水平，减少失血和输血，并改善心输出量、指数和全身血管阻力。然而，这并没有减少重症监护室或医院的住院时间。大多数研究是单中心前瞻性非盲试验，包括一小群选择性冠状动脉旁路移植术患者，这使得其无法提供有关临床结局的无偏倚证据。需要适当设计和进行前瞻性随机研究，以回答改良超滤对手术相关全身炎症分子的有益作用是否可以转化为临床结局的改善。
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was the impact of modified ultrafiltration on adult patients undergoing cardiac surgery in terms of inflammatory and metabolic changes, blood loss and early clinical outcomes. A total of 155 papers were identified using the search as described below. Of these, six papers presented the best evidence to answer the clinical question as they reported data to reach conclusions regarding the issues of interest for this review. The author, date and country of publication, patient group, study type and weaknesses and relevant outcomes were tabulated. Modified ultrafiltration in adult patients undergoing cardiac surgery seems to attenuate the levels of inflammatory molecules associated with surgery, reduces blood loss and blood transfusion and improves cardiac output, index and systemic vascular resistance. However, this was not translated in any reduction in length of stay in intensive care unit or hospital. Most studies were single-centre prospective non-blinded trials that included a small cohort of elective coronary artery bypass grafting patients, which makes it underpowered to provide unbiased evidence regarding clinical outcomes. Properly designed and conducted prospective randomized studies are required to answer whether the beneficial effect of modified ultrafiltration on systemic inflammatory molecules associated with surgery can translate with improvement in clinical outcome.