经左右桡动脉行冠状动脉造影术效果的荟萃分析  

A meta-analysis of randomized controlled trials comparing left with right radial approach for coronary angiography

作　　者：牛小伟[1] 杨翠玲[2] 贺生亮[1] 陈德[1] 燕东[1] 何智余[3] 姚亚丽[3] 

机构地区：[1]兰州大学第一临床医学院,730000 [2]西安交通大学医学院 [3]兰州大学第一医院心血管内科

出　　处：《中华心血管病杂志》2014年第3期241-246,共6页Chinese Journal of Cardiology

摘　　要：目的 评价经左右桡动脉行冠状动脉造影术的效果.方法 计算机检索PubMed、Embase、Web of Science 、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、万方数据库和中国知网,时间从建库至2013年1月.由2名研究人员独立按照纳入和排除标准以及Cochrane协作网推荐的方法筛选文献、评价质量,并采用Revman 5.1软件进行荟萃分析.结果 共纳入11项研究,包括5 442例患者.荟萃分析显示：与经右桡动脉途径比较,经左桡动脉途径行冠状动脉造影术没有增加手术失败率（OR=1.04,95％ CI0.80 ～ 1.35,P＞0.05）；在对比剂用量方面两者差异无统计学意义（均数差=2.39,95％ CI-0.30 ～5.08,P＞0.05）；经左桡动脉途径透视时间短于经右桡动脉途径（标准化均数差=0.15,95％ CI0.06 ～0.24,P＜0.01）；经右桡动脉途径出现严重锁骨下动脉迂曲的可能性是经左桡动脉途径的4.65倍（OR =4.65,95％ CI 1.98 ～ 10.88,P＜0.01）.结论 与经右桡动脉途径比较,经左桡动脉途径行冠状动脉造影术同样安全,且有一定的优势.左桡动脉既可以作为冠状动脉造影术的备选途径,也可以作为常规初始途径.Objective To compare the efficacy between left radial approach （LRA） and right radial approach （RRA） for coronary angiography （CAG）. Methods The following databases were searched, including PubMed, Embase, Web of science, Cochrane Library, CBM, VIP,Wanfang databases and CNKI, from creation of database to January 2013. Two reviewers extracted data independently, according to inclusive criteria, exclusion criteria and methods of Coehrane Collaboration. Statistical analysis was performed using Review Manager Software （ RevMan 5.1 ）. Results Eleven trials with 5 442 patients were included in the systematic review. The results of meta-analysis showed that when compared with RRA, LRA did not increase the failure rate of the procedures （ OR = 1.04, 95% CI 0. 80 - 1.35, P 〉0. 05） and amount of contrast medium（ mean difference = 2. 39, 95% CI - 0. 30 - 5.08 ） , P 〉 0.05 ）. However, LRA was superior to RRA in reducing fluoroscopy time （ standardized mean difference = 0. 15, 95% CI 0. 06 - 0. 24, P 〈0. 01 ）. In addition, the incidence of severe tortuosity of subclavian artery was significantly lower with LRA （0R=4.65,95%CI1.98 -10. 88, P〈0.01）. Conclusions Based on the current evidence, LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects. LRA can thus be used either as an alternative approach or routine approach for CAG.

关 键 词：桡动脉 冠状血管造影术 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]