Meta分析：尼可地尔治疗慢性心力衰竭的疗效观察  

Clinical efficacy of Nicorandil in chronic heart failure:Meta-analysis

作　　者：罗碧辉[1,2] 吴平生[1] 卜彤[2] 曾昭华[2] 

机构地区：[1]南方医科大学附属南方医院心内科,广州510515 [2]广州医学院第一附属医院心内科,广州510120

出　　处：《临床心血管病杂志》2013年第6期435-439,共5页Journal of Clinical Cardiology

摘　　要：目的:系统评价尼可地尔治疗慢性心力衰竭(心衰)的临床疗效。方法:搜索cochrane对照试验注册数据库、PubMed、MEDLINE、EMbase、CBM、CNKI及万方数据资源,收集自数据库建立初始至2012年3月实施尼可地尔治疗慢性心衰的临床随机对照试验相关文献。由2名评价者独立评价纳入研究的质量,提取资料并交叉核对,采用Stata11.0软件进行Meta分析。结果:共纳入9个研究,共计279例患者。Meta分析结果显示:①与静脉应用硝酸甘油相比较,静脉连续应用尼可地尔24h,可引起心率轻度增快(P=0.005),肺毛细血管楔压(PCWP)明显降低(P=0.026),全身血管阻力(SVR)明显下降(P=0.001),但右房压(RAP)、心脏指数(CI)、平均动脉压(MBP)的变化与硝酸甘油组相比差异无统计学意义;②单次剂量口服40mg或60mg尼可地尔片,有助于降低PCWP、SVR及MBP,但1h的药效对心率影响不明显(P=0.965);③在传统治疗方案,包括洋地黄、利尿剂、血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)、β受体阻滞剂及硝酸酯类等的基础上,加用口服尼可地尔5mg,每天3次,短期效果及长期持续应用5～6个月,均可以明显改善左室射血分数(LVEF)(P=0.001)。结论:在传统治疗方案基础上,无论是否与其他血管扩张剂合用,经口服途径或静脉途径应用尼可地尔,均可改善由缺血性心肌病(含PCI术后6个月的患者)、扩张性心肌病、瓣膜性心脏病、高血压性心脏病等引起的慢性充血性心衰患者的LVEF、PCWP及SVR,使之获得较好的疗效。Objective：To evaluate the clinical efficacy of Nicorandil on chronic heart failure by Meta-analysis. Method：We carefully screened randomized controlled trials about Nicorandil in the treatment of chronic heart fail- ure from the Cochrane Library,PubMed,MEDLINE,EMBASE,CBM,CNKI,Wanfang Data Resources.Two reviewers independently screened articles,assessed methodological quality of included studies,extracted data,and cross-checked.Any disagreements were resolved by consensus.We performed Meta-analysis using Stata11.0soft- ware.Result：Nine studies with a total of 279patients were included in our systematic review.Meta-analysis results showed that：①Compared with nitroglycerin injection,intravenous application of Nicorandil continuously for 24 hours increased heart rate slightly（P=0.005）,decreased PCWP and SVR significantly（both P〈0.05）,but the changes of RAP,CIand MBP were not significant.②Single oral dose of 40mg or 60mg Nicorandil tablet reduced PCWP,SVR,and MBP,wothout significant effect on HR.③On the basis of traditional treatment programs （including Digitalis,Diuretics,ARB,BB,Nitrates）,LVEF was significantly improved by oral Nicorandil tablet 5mg three times a day for short-term （1week）or long-term （5-6months）application（P=0.001）.Conclusion： On the basis of traditional treatment programs,whether in combination with other vasodilators or not,Nicorandil is available for patients with chronic heart failure caused by coronary artery disease（including patients with PCI after 6months）,dilated cardiomyopathy,valvular heart disease or hypertensive heart disease.Both oral and intra- venous administrations of Nicorandil can improve LVEF,PCWP and SVR in patients with chronic heart failure.

关 键 词：心力衰竭 慢性 尼可地尔 META分析 

分 类 号：R542.2[医药卫生—心血管疾病]