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目的系统评价改良单片法在完全性房室隔缺损术中和术后疗效的优势。方法计算机检索PubMed和Annual Reviews、中国知网、万方数据库、读秀学术搜索等数据库查找文献,检索日期截至2016年3月,根据纳入标准对文献进行筛选和评估,采用STATA 11.0软件进行Meta分析,比较双片法和改良单片法术中和术后疗效,结果以平均差(SMD),合并RR值和95%可信区间(CI)表示。结果 Meta分析结果提示,改良单片法在体外循环时间、主动脉阻断时间、住院时间和住ICU时间、死亡人数上较双片法有显著优势(SMD=-0.93,95%CI-1.24~-0.61,P=0.000;SMD=-1.02,95%CI-1.39~-0.66,P=0.000;SMD=-0.10,95%CI-0.43~-0.23,P=0.035;SMD=-0.12,95%CI-0.29~-0.05,P=0.555;RR=0.93,95%CI 0.66~1.30,P=0.031),而再次手术率方面,差异无统计学意义(RR=0.87,95%CI 0.65~1.17,P=0.398)。结论改良单片法较双片法在手术时间及住院时间的缩短、死亡率的减少上有较大优势,同时可以减少因为体外循环而带来的相关并发症,但再次手术率差异无统计学意义。
Objective To systematically evaluate the advantages of modified monolithic method in the treatment of complete atrioventricular septal defect and postoperative effect. Methods The databases of PubMed and Annual Reviews, China National Knowledge Infrastructure, Wanfang Database, and Xiu Xiu Academic Search were searched by computers. The search date was up to March 2016, and the literature was screened and evaluated according to inclusion criteria. Meta-analysis was performed using STATA 11.0 software , Comparing the two-slice method and the modified monolithic method and the postoperative curative effect, the results were expressed as mean difference (SMD), combined RR and 95% confidence interval (CI). Results The results of Meta analysis indicated that the improved monolithic method had significant advantages over bi-slice method in the duration of cardiopulmonary bypass, the time of aortic block, length of stay in hospital and living in ICU (SMD = -0.93, 95% CI-1.24 ~ -0.61, P = 0.000; SMD = -1.02, 95% CI-1.39 to -0.66, P = 0.000; SMD = -0.10, 95% CI -0.43 to -0.23, P = CI = 0.29-0.05, P = 0.555; RR = 0.93, 95% CI 0.66-1.30, P = 0.031). There was no significant difference in the rate of reoperation (RR = 0.87,95% CI 0.65-1.17, P = 0.398). Conclusion Compared with the double-slice method, the modified monolithic method has the advantages of shorter operation time, shorter hospital stay and lower mortality, and can reduce the complications associated with cardiopulmonary bypass. However, there is no statistical difference in the rate of reoperation significance.