普罗帕酮与胺碘酮转复心房颤动效果的Meta分析  

Effectiveness and safety of propafenone versus amiodarone in cardioversion of atrial fibrillation:A Meta-analysis

作　　者：程征[1] 周子华[1] 陈玺军 

机构地区：[1]华中科技大学附属协和医院,武汉430032

出　　处：《临床心血管病杂志》2016年第7期702-706,共5页Journal of Clinical Cardiology

摘　　要：目的:系统评价普罗帕酮与胺碘酮转复心房颤动(房颤)的疗效以及安全性。方法:通过计算机检索中英文电子文献数据库,收集有关普罗帕酮以及胺碘酮治疗房颤的随机对照试验(RCTs),由两位评估者独立进行筛选以及评价,对合格的文献应用RevMan5.2软件进行Meta分析。结果:共纳入符合标准的RCTs文献12篇,Meta分析结果提示:1用药后观察时间充分的条件下(观察时间≥24h)转复房颤的有效性普罗帕酮组差于胺碘酮组(OR=0.55,95%CI:0.38~0.80,P=0.02)。2用药后转复房颤的平均转复时间普罗帕酮组明显短于胺碘酮组(WMD=-3.48h,95%CI:-5.23h^-1.73h,P<0.000 1),口服普罗帕酮组转复房颤时间明显短于口服胺碘酮组(WMD=-5.28h,95%CI:-6.84h^-3.71h,P<0.000 01),静脉普罗帕酮组转复房颤时间明显短于静脉胺碘酮组(WMD=-2.58h,95%CI:-4.35h^-0.81h,P<0.000 01)。312组RCTs显示普罗帕酮组与胺碘酮组在总不良反应、心血管系统内不良反应、心血管系统以外的不良反应及严重不良事件上均无明显统计学差异。结论:在观察时间(≥24h)充分的条件下,胺碘酮具备更高的转复率,但普罗帕酮具备更快的转复时间。两组不良反应发生率不具有统计学差异,安全性无显著差异。Objective：To evaluate the therapeutic effectiveness and safety of propafenone versus amiodarone in the cardioversion of atrial fibrillation.Method：An electronic search in databases included both English and Chinese randomized controlled trials（RCTs）about propafenone versus amiodarone in the cardioversion of atrial fibrillation.Two reviewers independently screened the studies and extracted the data,assessed the methodological quality,and then performed Meta-analysis by using Revman 5.2software.Result：Twelve RCTs were finally included.The result of Meta-analysis showed：1Under the condition of sufficient observation time after the treatment,the effective rate alleviating atrial fibrillation in the propafenone group was inferior to that of the amiodarone group（OR=0.55,95%CI：0.38-0.80,P=0.02）.2After the treatment,propafenone group took shorter time to alleviate atrial fibrillation（WMD=-3.48 h,95%CI：-5.23h～-1.73 h,P0.000 1）.The result of subgroup analysis indicated：Oral Loading dose of propafenone took shorter time than that of amiodarone in alleviating atrial fibrillation（WMD=-5.28 h,95%CI：-6.84h～-3.71 h,P0.000 1）.Similarly,intravenous propafenone took shorter time than intravenous amiodarone in alleviating atrial fibrillation（WMD=-2.58 h,95%CI：-4.35h～-0.81 h,P0.000 1）.312 RCTs showed that the adverse effect rates in the two groups had no significant difference in the aspects of total adverse effect,adverse cardiovascular responses,the side-effect except of cardiovascular system and serious adverse events.Conclusion：Compared with amiodarone,propafenone has a lower effective rate in cardioversion of atrial fibrillation,but propafenone obviously takes shorter time in alleviating atrial fibrillation,and there is no significant difference in the adverse effect rates.

关 键 词：普罗帕酮 胺碘酮 心房颤动 复律 META分析 

分 类 号：R541.7[医药卫生—心血管疾病]