中国人群右心室室间隔起搏与右心室心尖部起搏疗效和安全性的Meta分析  

Meta-analysis for the Efficacy and Safety of Right Ventricular Septum Pacing and Right Ventricular Apical Pacing in Chinese Population

作　　者：白明[1] 庞军[1] 李强[1] 汪涛[1] 邓爱云[1] 陈长源[1] 赵存瑞 王世杰[1] 药素毓[1] 葛均波[2] 杨跃进[3] 张钲[1] 

机构地区：[1]兰州大学第一医院心内科,甘肃省兰州市730000 [2]复旦大学附属中山医院 [3]阜外心血管病医院

出　　处：《中国循环杂志》2015年第8期766-770,共5页Chinese Circulation Journal

摘　　要：目的:系统评价中国人群右心室室间隔(RVS)起搏与右心室心尖部(RVA)起搏的疗效和安全性。方法:计算机检索Pub Med、Embase、Cochrane图书馆、CNKI、VIPH和万方数据库,检索时间截止2015-01。纳入有关中国人群RVS与RVA的临床试验,根据Cochrane Handbook 5.0.2质量评价标准评纳入研究质量。由两名研究员独立进行文献筛选、资料提取和质量评估,采用Rev Man5.0软件进行Meta分析。结果:纳入16篇随机对照研究(RCT)文献共包括1 199例患者,RVS起搏患者602例(RVS组),RVA起搏患者597例(RVA组)。两组疗效判断指标Meta分析结果:在左心室射血分数(LVEF)术后与术前差值[合并值均数差(MD)=1.90,95%CI:0.75~3.05,P=0.001]、每搏输出量(SV)术后与术前差值(合并值MD=7.08,95%CI:2.39~11.76,P=0.003)、QRS波宽度术后与术前差值(合并值MD=29.13,95%CI:5.71~52.54,P=0.01)、左心室收缩末期容积(LVESV)术后与术前差值(合并值MD=2.04,95%CI:-4.22~8.31,P<0.00001)、左心室舒张末期容积(LVEDV)术后与术前差值(合并值MD=2.64,95%CI:1.80~3.49,P<0.00001)、B型利钠肽(BNP)术后与术前差值(合并值MD=68.00,95%CI:57.57~78.43,P<0.00001)、室间隔与左心室后壁运动延迟时限(SPWMD)术后与术前差值、(合并值MD=22.68,95%CI:16.91~28.45,P<0.00001)、二尖瓣血流E峰和A峰最大充盈速度比值(E/A)(合并值MD=0.49,95%CI:0.41~0.57,P<0.00001)、左右心室射血前时间差值(LRVPEI)术后与术前差值(合并值MD=14.06,95%CI:12.36~15.75,P<0.00001)、电极阻抗(合并值MD=-67.02,95%CI:-119.96^-14.08,P=0.01)、起搏阈值(合并值MD=0.09,95%CI:0.00~0.18,P=0.04)方面RVS组优于RVA组。手术时间RVS组相对于RVA组更长(合并值MD=-11.76,95%CI:-14.69^-8.82,P<0.00001)。在左心室舒张末期内径(LVEDD)术后与术前差值、Tei指数和X线曝光时间方面RVS组与RVA组相似,差异无统计学意义(P>0.05)。结论:RVS起搏相对于RVA起搏可更佳改善中国人群LVEF、SV、QRS波宽度、LVESV、LVEDV、B型利�Objective： To systemically evaluate the efficacy and safety of right ventricular septum （RVS） pacing and right ventricular apical （RVA） pacing in Chinese population. Methods： A computer searching was conducted in PubMed, Embase, Cochrane library, CNKI, VIPH and Wanfangdatabase until 2015-01, and all randomized controlled trials （RCT） upon （RVS） pacing and （RVA） pacing in Chinese population were enrolled. According to Cochrane Handbook 5.0.2 quality evaluation criteria, the publications were selected by 2 independent researchers and Meta-analysis was conducted with RevMan5.0 software. Results： A total of 16 RCT articles including 1199 patients were enrolled in this study. The research was divided into 2 groups： RVS group, n=602 and RVA group, n=597. Meta-analysis indicated that the following indexes in RVS group were better than those in RVA group： the differences between post-and pre-operation for the combination value in LVEF （MD=1.90, 95% CI 0.75-3.05, P=0.001）, stroke volume （MD=7.08, 95% CI 2.39-11.76, P=0.003）, QRS wave width （MD=29.13, 95% CI 5.71-52.54, P=0.01）, LVESV （MD=2.04, 95% CI -4.22 to 8.31, P〈0.00001）, LVEDV （MD=2.64, 95% CI 1.80-3.49, P〈0.00001）, BNP （MD=68.00, 95% CI 57.57-78.43, P〈0.00001）, inter ventricular septum and left ventrieular posterior wall motion delay time （SPWMD） （MD=22.68, 95% CI 16.91-28.45, P〈0.00001）, E/A （MD=0.49, 95% CI 0.41-0.57, P〈0.00001）, LRVPEI （MD=14.06, 95% CI 12.36-15.75, P〈0.00001）, resistance of electrode （MD=-67.02, 95% CI -119.96 to -14.08, P=0.01） and pacing threshold （MD=0.09, 95% CI 0.00-0.18, P=0.04）. The time of operation in RVS group was longer than that in RVA group, （MD=-11.76, 95% CI -14.69 to -8.82, P〈0.00001）. The differences between post- and pre- operation in LVEDD, Tei index and X-ray exposure time were similar between 2 groups, P〉0.05. Conclusion： RVS is a relatively feasible pacing method in Chinese population.

关 键 词：室间隔 右心室心尖部 起搏 中国人群 META分析 

分 类 号：R54[医药卫生—心血管疾病]