国内易化PCI与直接PCI治疗ST段抬高性心肌梗死有效性及安全性Meta分析  

Meta analysis of the efficacy and safety of facilitated PCI versus primary PCI for ST-segment elevation myocardial infarction in China

作　　者：阿尔帕提.买买提 杨晓萍[2] 彭鹏[1] 

机构地区：[1]新疆医科大学第一附属医院急救中心,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院体检与健康管理中心,新疆乌鲁木齐830054

出　　处：《中国现代医学杂志》2014年第10期60-66,共7页China Journal of Modern Medicine

摘　　要：目的评价易化PCI对比直接PCI治疗国内ST段抬高性心肌梗死患者的有效性及安全性。方法计算机检索CBM（1978~2011）和CNKI（1979~2011）并手工检索发表的资料和会议论文并追索纳入文献的参考文献,查找国内关于比较易化PCI对比直接PCI治疗ST段抬高性心肌梗死的相关病例-对照试验。对纳入研究进行方法学质量评价之后,采用RevMan 5.1软件进行Meta分析。结果共纳入10个国内相关病例-对照研究,合计1 307例患者。Meta分析结果表明：与直接PCI治疗ST段抬高性心肌梗死相比,易化PCI可以提高IRA介入术后TMIⅢ级血流率[RR=2.74,95%CI（1.09,6.92）],改善冠状动脉造影IRA开通率[RR=2.41,95%CI（1.25,4.62）],提高术后左室射血分数[WMD=6.09,95%CI（1.92,10.27）]。而在IRA介入术后TMI血流Ⅱ级[RR=1.36,95%CI（0.60,3.09）],术后死亡[RR=0.56,95%CI（0.30,1.05）],术后再发梗死[RR=0.54,95%CI（0.27,1.09）],术后出血[RR=1.31,95%CI（0.82,2.09）]等方面差异没有显著性。结论与直接PCI治疗ST段抬高性心肌梗死相比,易化PCI具有显著的临床疗效和较高的安全性,值得进一步研究探索及推广应用,尤其是在距离有完善相关设备的偏远地区。【Objective】To evaluate the efficacy and safety between facilitated PCI and primary PCI on ST-segment elevation myocardial infarction in China. 【Methods】The controlled trials about facilitated PCI and primary PCI on ST-segment elevation myocardial infarction were electronically searched from the CBM（1978~2011） and CNKI（1979~2011）, and the relevant published and unpublished data and their references in Chinese were also searched by hand. The data were extracted and the methodological quality of the incorporated research was evaluated by two reviewers independently, and the RevMan 5.1 software was used for Meta-analysis. 【Results】Ten controlled trials involving 1 307 patients were included. Meta-analysis showed that compared with primary PCI in the treatment of ST-segment elevation myocardial infarction in patients, the facilitated PCI was better in improving the rate of TMI grade 3 before angioplasty after IRA[RR=2.74, 95% CI（1.09, 6.92）] and the patency rate of coronary artery angiography IRA[RR=2.41, 95% CI（1.25, 4.62）], increasing the postoperative left ventricular ejection fraction[WMD=6.09, 95% CI（1.92, 10.27）]. But there was no significant difference in the respect such as the rate of TMI grade 2 before angioplasty after IRA [RR=1.36, 95% CI（0.60, 3.09）], postoperative death [RR=0.56, 95% CI（0.30, 1.05）], postoperative recurrent infarction [RR=0.54, 95% CI（0.27, 1.09）], postoperative bleeding [RR=1.31, 95% CI（0.82, 2.09）]. 【Conclusion】Compared with primary PCI treatment of ST-segment elevation myocardial infarction, facilitated PCI has significant clinical efficacy and high safety, and it is worthy to be explored and promoted about the use of this study, especially in remote areas without the relevant equipment.

关 键 词：易化PCI 直接PCI ST段抬高性心肌梗死 对照试验 系统评价 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]