心脏外科手术后患者再入ICU发生率的系统评价和meta分析

目的 了解心脏外科手术后患者再入重症监护病房（intensive care unit ICU）的发生率及其死亡率，并分层分析。方法 制定原始文献的纳入标准及检索策略，计算机检索中国期刊全文数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方医学及PubMed、Elsevier数据库，提取有效数据，分别对再入ICU发生率、再入ICU病例死亡率、呼吸系统原因再入率和循环系统原因再入率 4项指标，依据资料的不同地域来源、不同年龄来源、不同病种来源和不同时间来源按段4个亚组分层研究，采用RevMan5.3 软件进行meta分析。 结果 纳入研究文献22篇，共报道89 981例，再入ICU 2 717例，再入病例死亡478例，meta分析结果显示再入ICU总发生率为3%(95%CI=0.03~ 0.04，P＜0.01)，再入ICU病例总死亡率为18%(95%CI=0.15~0.21，P＜0.01)，呼吸系统原因再入ICU发生率为39%(95%CI=0.33~0.44，P＜0.01)，循环系统原因再入ICU发生率为29%(95%CI=0.25~0.34，P＜0. 01)。再入ICU发生率国内低于国外、小儿低于成人、2011年后低于2010年前、先心病低于冠状动脉旁路移植术（CABG）；再入ICU病例的死亡率国内也低于国外、先心病低于CABG。结论 心脏外科手术后再入ICU虽发生率不高，但再入ICU病例的死亡率甚高。

A systematic review and meta analysis of the incidence of readmission into cardiac intensive care unit

Objective To evaluate the incidence and mortality of reentry ICU after cardiac surgery，and to analyze them by stratification.Methods The inclusion criteria and retrieval strategy of original literature were established. Such databases as Chinese Periodical Full Text Database, Chinese BioMedical Literature Database, Full Text Database of Chinese Sci Tech Periodical, Wanfang Database, PubMed and Elsevier were searched electronically to extract valid data. Associations between the incidence and mortality of reentry ICU, the perioperative risk factors such as circulatory and respiratory complications, were stratified by geographical, age, diseases and different time periods. All the data were analyzed with RevMan 5.3 software. Results A total of 22 articles were included in this study, and 89 981 patients were enrolled. The number of readmission and deaths were 2 717 and 478 respectively. The total incidence of reentry ICU was 3%(95%CI=0.03 0.04，P＜0.01); reentry ICU rate for respiratory reason was 39%(95%CI=0.33 0.44，P＜0.01), and for circulatory reason was 29%(95%CI=0.25 0.34，P＜0.01). The rate of reentry ICU was lower athome than that abroad, lower in children than that among adults,lower after 2011 than that before 2010, and lower in congenital heart disease than that in CABG. The total mortality of reentry ICU cases was 18%(95%CI=0.15 0.21，P＜0.01). The mortality abroad was higher than that at home,and the mortality in congenital heart disease is lower than in CABG. Conclusion The rate of readmission into cardiac intensive care unit is low, but the mortality of the ones that have been readmitted is quite high.