急性心肌梗死患者溶栓失败后主要治疗方法有效性及安全性的系统评价  

Effect and safety of the therapies for acute myocardial infarction patients with failed thrombolytic therapy:a systematic review

作　　者：张小利[1] 李静[1] 艾昌林[1] 袁文明[1] 何林[2] 张冬萍[3] 

机构地区：[1]四川大学华西医院循证医学与临床流行病学教研室,四川成都610041 [2]四川大学华西医院图书馆,四川成都610041 [3]四川大学华西医院神经内科,四川成都610041

出　　处：《南方医科大学学报》2009年第3期437-441,共5页Journal of Southern Medical University

摘　　要：目的采用Cochrane系统评价方法对急性心肌梗死患者溶栓失败后主要治疗方法的有效性、安全性进行评价,为合理选择治疗措施提供临床研究证据。方法系统检索Cochrane图书馆临床对照试验数据库(2006年2期),MEDLINE(1966～2006.7)、EMBASE(1984～2006.7)、CNKI(1994～2006.7)、CBMdisc(1980～2006.7),语种限制为中文和英文。手工检索《中华心血管病杂志》等8种杂志及已纳入文献的参考文献。纳入有关溶栓失败后主要治疗方法的随机对照试验(RCTs),由2人独立进行质量评价。采用Cochrane协作网提供的RevMan4.2.8进行分析。结果共纳入9个RCTs。Meta分析结果显示:(1)补救性PCI与传统疗法比较,补救性PCI组病死率低于传统疗法组[RR=0.64,95%CI(0.41～0.98)];补救性PCI组缺血性脑卒中发生率、出血发生率高于传统疗法组[RR=4.39,95%CI(1.14～16.87);RR=2.79,95%CI(1.55～5.02)]。(2)再溶栓与传统疗法比较:再溶栓组血管再通率高于传统疗法组[RR=2.92,95%CI(1.75～4.85)]。(3)补救性PCI与再溶栓比较:补救性PCI组血运重建率低于再溶栓组[RR=0.57,95%CI(0.34～0.95)];补救性PCI组出血发生率高于再溶栓组[RR=2.15,95%CI(1.27～3.63)]。(4)GPⅡb/Ⅲa受体抑制剂与基础治疗比较:两组病死率、出血发生率差异无统计学意义。结论4种溶栓失败后的治疗方法,除补救性PCI较传统疗法能降低病死率外,其余疗法尚无确切证据支持哪种更有效,且存在出血的并发症,因此还不能作为常规治疗方案。Objective To assess the effect and safety of therapies in common use for acute myocardial infarction （AMI） patients with failed thrombolytic therapy. Methods We searched the Cochrane Central Register of Controlled Trials （CENTRAL, Issue 2, 2006）, MEDLINE （1966 to July 2006）, EMBASE （1984 to July 2006）, China National Knowledge Infrastructure （CNK/, 1994 to July 2006）, China Biomedicine Database disc （CBMdisc, 1980 to July 2006）. We also searched several key Chinese journals in the field of cardiovascular diseases. The language was limited to Chinese and English. We included all the randomized controlled trials （RCTs） for acute myocardial infarction patients with failed thrombolytic therapy. Two authors independently assessed the methodological quality of the included studies, the data were analyzed by RevMan 4.2.8 from the Cochrane Collaboration. Results Nine RCTs met the inclusion criteria. A significant difference was found between the rescue percutaneous coronary intervention （PCI） group and conventional treatment group in the mortality rate at the end of the follow-up [RR=0.64, 95%CI （0.41, 0.98）]. Thromboembolic stroke and bleeding in rescue PCI group were significantly higher than that in conventional treatment group [RR=4.39, 95%CI （1.14, 16.87）, and RR=2.79, 95%CI （1.55, 5.02）, respectively]. Compared with conventional therapy, rescue thrombolytic treatment was associated with a significantly higher reperfusion rate [RR=2.92, 95%CI （1.75, 4.85）]. Comparison between rescue PCI with rescue thrombolytic treatment revealed that the revascularization rate in rescue PCI group was significantly lower than that in rescue thrombolytic group [RR=0.57, 95%CI （0,34, 0.95）], and the incidence of bleeding was significantly higher in rescue PCI group [RR=2.15, 95%CI （1.27, 3.63）]. Comparison of glycoprotein （GP） Ⅱ b/Ⅲ a receptor antagonists with standard treatment showed no significant difference between them in the mortality rate and bleeding rate at the e

关 键 词：补救性PCI 心肌梗死 溶栓 系统评价 

分 类 号：R542.22[医药卫生—心血管疾病]