WATCHMAN和Amplatzer封堵器有效性及安全性的meta分析  

Efficacy and safety of WATCHMAN and Amplatzer cardiac plug in atrial fibrillation:a meta-analysis

作　　者：何贵均 黄晶[1] 熊青松 胡骏豪 刘嘉玲 周骐[1] HE Guijun;HUANG Jing;XIONG Qinsong;HU Junhao;LIU dialing;ZHOU Qi(The Second Affiliated Hospital of Chongqing Medical University,Chongqing,400000,China)

机构地区：[1]重庆医科大学附属第二医院,重庆400010

出　　处：《临床心血管病杂志》2018年第11期1058-1064,共7页Journal of Clinical Cardiology

摘　　要：目的:比较WATCHMAN和Amplatzer cardiac plug(ACP)左心耳封堵器的安全性及有效性。方法:通过计算机检索Pubmed、Embase、Cochrane数据库中比较WATCHMAN和ACP的文章,包括随机对照试验(RCT)、病例登记及观察性研究。主要结局为WATCHMAN和ACP封堵器随访中缺血性卒中发生率、手术成功率、术中器械更换率、术中出血、手术并发症;次要结局为随访中心血管死亡率。结果:总共纳入25篇相关文章(23篇病例登记及观察性研究,2篇RCT),总例数为10 340例。汇总分析表明,ACP术中器械更换套数较WATCHMAN更少(1.08套∶1.34套,P<0.05);术中ACP较WATCHMAN出血风险升高,但差异无统计学意义(2.8/P∶1.6/P,P>0.05);ACP手术严重并发症较WATCHMAN升高(1.8/P∶3.9/P)。随访WATCHMAN和ACP发生缺血性卒中及心血管死亡无明显统计学差异。结论:WATCHMAN较ACP更耗费器材,但ACP手术时有更高的严重并发症风险。随访数据表明WATCHMAN与ACP预防心房颤动所致缺血性卒中效果相当。Objective：To research efficacy and safety of left atrial appendage occlusion devices WATCHMAN and Amplatzer cardiac plug（ACP）.Method：PubMed,Embase and Cochrane databases were searched for publications that related to WATCHMAN and ACP,including randomized controlled trials（RCT）and registration and observation trials.Primary outcomes included the incidence of ischemic stroke during follow-up,the success rate of surgery,the number of operative devices required,the operative bleeding and the surgical complications;Secondary outcomes included cardiovascular mortality during follow-up.Result：A total of 25 related articles（23 case registration and observational studies and 2 RCTs）with 10 340 cases were included.Summary analysis showed that ACP occluder had lower chance of replacement（1.08 sets∶1.34 sets,P〈0.05）,higher operative bleeding risk（2.8/P∶1.6/P,P〉0.05）and surgery complications（1.8/P∶3.9/P）.Follow-up analysis showed that there was no significant difference in ischemic stroke and cardiovascular death between WATCHMAN and ACP.Conclusion：Wacthman needs more equipment,ACP has a higher risk of serious complications during surgery.The efficacy in preventing ischemic stroke due to atrial fibrillation is comparable between WATCHMAN and ACP.

关 键 词：心房颤动 左心耳封堵器 META分析 

分 类 号：R541.7[医药卫生—心血管疾病]