肺血管扩张剂治疗Fontan手术术后肺动脉高血压患者的疗效及安全性的系统评价及Meta分析  

Efficacy and safety of pulmonary vasodilators in patients with pulmonary artery hybertension Fontan circulation: a Meta-analysis of randomizedcontrolled trials

作　　者：王吴婉 胡贤康 廖尉廷 曾小芳 封盼攀[1] 黄玮[1] WangWu-wan;Hu Xian-kang;LiaoWei-ting;Zeng Xiao-fang;Feng Pan-pan;HuangWei(Department of Cardiology,The First Affiliated Hospital with Chongqing Medical University,Chongqing 400016,China;The First Clinical School,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院心内科,重庆400016 [2]重庆医科大学第一临床学院,重庆400016

出　　处：《兰州大学学报（医学版）》2018年第5期9-15,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：国家自然科学基金项目(81170188,30971212).

摘　　要：目的采用系统评价和Meta分析方法综合评价肺血管扩张剂治疗Fontan术后肺动脉高血压(PAH)患者的有效性及安全性。方法用PubMed、Embase、Cochrane数据库以及Clinical trial.gov检索有关肺血管扩张剂治疗Fontan循环患者的随机对照研究。在2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用STATA 12.0软件进行Meta分析。纳入9篇文献、382例患者随机对照研究。结果Meta分析结果显示,肺血管扩张剂组与对照组相比,Fontan术后PAH患者的NYHA心功能分级明显改善,6分钟步行试验显著增加,运动峰值摄氧量增加,右心导管测得平均肺动脉压下降。但两组的死亡率和NT-proBNP的差异无统计学意义。4篇文献报道患者对肺血管扩张剂有较好的耐受性,无药物副作用;另外有2篇文献报道有轻度的药物副作用。结论肺血管扩张剂能明显改善Fontan术后PAH患者的心功能和运动耐量,并降低肺循环阻力,但不能降低PAH患者的死亡率。Objective No previous Meta-analysis has evaluated the efficacy and safety of pulmonary vasodilators in patients pulmonary artery hybertension(PAH)with Fontan procedure.Methods Relevant studies published were identified through a search of the PubMed,Embase,Cochrane databases and Clinical trial.gov Pooled outcomes were determined to assess the efficacy and safety of pulmonary vasodilators in Fontan patients.Results Nine randomized controlled studies involving 381 patients with Fontan circulation were included.Pulmonary vasodilator therapy led to significant reduction in the mean pulmonary artery pressure(mPAP)and to a significant improvement in New York Heart Association(NYHA)functional class.The 6-minute walk distance(6 MWD)was significantly increased,and the peak oxygen consumption(VO2)was also likewise improved in the pulmonary vasodilator group.No significant change was found in mortality and brain natriuretic peptide(BNP)or N-terminal B-type natriuretic peptide(NT-proBNP)levels.Four studies reported no side effects,but with good drug tolerance,and two studies reported mild adverse effects.Conclusion Pulmonary vasodilators,could evidently improve hemodynamic indicators,including mPAP and peak VO2,peak oxygen consumption.

关 键 词：FONTAN手术 5-磷酸二酯酶抑制剂 内皮素受体拮抗剂 有效性 安全性 

分 类 号：R544.1[医药卫生—心血管疾病]