冠状动脉内注射腺苷使ST段抬高型心肌梗死患者临床获益的Meta分析  

The clinical benefit of coronary injection of adenosine in patients with ST-elevation myocardial infarction:A Meta analysis

作　　者：姚克铖 邹秀兰[1] 易偲[2] 

机构地区：[1]三峡大学人民医院宜昌市第一人民医院综合内科,湖北宜昌443000 [2]三峡大学人民医院宜昌市第一人民医院心内科

出　　处：《临床心血管病杂志》2016年第7期685-689,共5页Journal of Clinical Cardiology

基　　金：2016三峡大学研究生科研创新基金项目(No:SDYC2016090)

摘　　要：目的：系统评价急性ST段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）时冠状动脉（冠脉）内辅助应用腺苷对心肌再灌注损伤及心肌梗死范围的改善作用。方法：电脑检索国内外数据库,纳入研究冠脉内辅助应用腺苷治疗急性STEMI患者的前瞻性随机对照试验。两名检索员独立进行检索、文献质量评价和数据提取,并对纳入研究的质量进行评价,使用Review Manager 5.3进行分析和图表制作。结果：最终纳入14篇文献,共4 331例病例。将其分为2个亚组：冠脉内注射腺苷组（9篇）和静脉使用腺苷组（5篇）。经冠脉注射腺苷的患者心力衰竭发生率明显降低（RR=0.44,95%CI：0.25～0.78,P=0.005）,且冠脉无复流的发生率降低（RR=0.65,95%CI：0.46～0.93,P=0.02）。静脉使用腺苷组中的心力衰竭发生率没有差异。经冠脉注射腺苷与静脉使用腺苷在非致命性心肌梗死和全因死亡率方面无显著差异。结论：经冠脉介入治疗中辅助使用腺苷可较好改善STEMI患者临床预后。Objective：To evaluate the clinical benefit of coronary injection of adenosine in patients with acute ST-elevation segment myocardial infarction（STEMI）during direct percutaneous coronary intervention（PCI）.Method：The prospective randomized controlled trials about application of adenosine in patients with acute STEMI were searched in the domestic and international databases.Two independent searchers retrieved and evaluated the quality of the included studies,then extracted data separately.The data analysis and chart production were made by Manager Review 5.3.Result：The final 14 studies were picked out which included 4 331 cases.It was divided into 2subgroups：intracoronary adenosine versus control（9RCTs）and intravenous adenosine versus control（5RCTs）.The incidence of heart failure in patients in intracoronary adenosine versus control group was significantly lower（RR=0.44,95%CI：0.25-0.78,P=0.005）and the incidence of coronary artery disease was significantly lower（RR=0.65,95%CI：0.46-0.93,P=0.02）.There was no difference of the incidence of heart failure in intravenous adenosine group,and there was no difference in the use of adenosine and adenosine in the non-fatal myocardial infarction and all-cause mortality.Conclusion：The application of adenosine in the treatment of coronary intervention can improve the clinical outcome of patients with STEMI.

关 键 词：ST段抬高型心肌梗死 腺苷 冠状动脉 META分析 

分 类 号：R541.4[医药卫生—心血管疾病]