经心腔内与经食管超声心动图引导下左心耳封堵术的系统评价与Meta分析  

Intracardiac echocardiography versus transesophageal echocardiography for left atrial appendage occlusion:A systematic review and meta-analysis

作　　者：郭琼 赵晴雯 顾先林 蒋桂昱 冯堃 龙囿霖 林逸飞[1,4] 黄进[1,3] 杜亮[1,3,5] GUO Qiong;ZHAO Qingwen;GU Xianlin;JIANG Guiyu;FENG Kun;LONG Youlin;LIN Yifei;HUANG Jin;DU Liang(Medical Device Regulatory Research and Evaluation Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;West China School of Public Health,Sichuan University,Chengdu,610044,P.R.China;Chinese Evidence-Based Medicine Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Precision Medicine Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;West China Periodical Press,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院医疗器械监管研究与评价中心,成都610041 [2]四川大学华西公共卫生学院,成都610044 [3]四川大学华西医院中国循证医学中心,成都610041 [4]四川大学华西医院精准医学研究中心,成都610041 [5]四川大学华西医院华西期刊社,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第11期1492-1502,共11页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(72074161)。

摘　　要：目的系统评价心腔内超声心动图(intracardiac echocardiography,ICE)与经食管超声心动图(transesophageal echocardiography,TEE)引导下左心耳封堵术(left atrial appendage occlusion,LAAO)的安全性、有效性和经济性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP和WanFang Database数据库,搜集比较ICE与TEE引导下LAAO的相关研究,检索时限均从建库至2022年6月15日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3和R 4.0.3软件进行Meta分析,剔除回顾性队列研究进行敏感性分析,对不同封堵器类型和ICE导管类型进行亚组分析。结果共纳入14个研究,6599例患者。Meta分析结果显示:ICE与TEE引导LAAO在技术成功率、总体并发症、器械栓塞、器械周围漏、器械相关血栓、卒中、血管并发症、出血、手术时间、透视时间和造影剂剂量方面差异均无统计学意义,但ICE组的导管室内总时间[MD=–33.47 min,95%CI(–41.20,–25.73),P<0.00001]、X线曝光量[MD=–170.20 mGy,95%CI(–309.79,–30.62),P=0.02]低于TEE组,而其心包积液/心脏压塞发生率高于TEE组[RR=1.57,95%CI(1.01,2.45),P=0.048]。除心包积液/心脏压塞外,亚组分析和敏感性分析得出相似结果。基于美国的费用数据分析显示ICE与TEE总费用相当,甚至更低,但目前尚缺乏国内费用比较研究。结论当前证据显示,使用ICE引导LAAO可减少X线曝光量和缩短导管室内总时间,且两组总体并发症发生率差异无统计学意义。受纳入研究样本量和质量的限制,本研究结论尚需要大样本高质量的随机对照试验加以验证。Objective To systematically evaluate the safety,efficacy,and economics of intracardiac echocardiography(ICE)versus transesophageal echocardiography(TEE)in left atrial appendage occlusion(LAAO).Methods PubMed,EMbase,The Cochrane Library,CBM,CNKI,VIP and WanFang Database were systematically searched to collect relevant studies on comparing ICE and TEE-guided LAAO from inception to June 15th,2022.Two reviewers independently screened the literatures,extracted the data,and assessed the risk of bias of the included studies.Meta-analyses were performed using RevMan 5.3 and R 4.0.3.Retrospective cohort studies were excluded for sensitivity analysis.Subgroup analyses were performed based on the types of occluder and ICE catheter.Results A total of 14studies with 6599 patients were included.Meta-analyses showed no statistical differences in technical success rate,overall complications,device embolization,peri-device leakage,device-related thrombus,stroke,vascular complications,bleeding,operation time,fluoroscopy time,or contrast agent volume between the ICE and TEE-guided LAAO.The total in-room time(MD=–33.47 min,95%CI–41.20 to–25.73,P<0.00001)and radiation dosage(MD=–170.20 mGy,95%CI–309.79 to–30.62,P=0.02)were lower in the ICE group than those in the TEE group,whereas the incidence of pericardial effusion/tamponade was higher than the TEE group(RR=1.57,95%CI 1.01 to 2.45,P=0.048).Except for pericardial effusion/tamponade,subgroup analyses and sensitivity analysis showed similar results.The analysis based on the cost data from the United States showed comparable or even lower total costs for ICE versus TEE,but comparative domestic cost studies were lacking.Conclusion Current evidence suggests that ICE-guided LAAO can reduce radiation dosage and total in-room time,and there is no statistical difference in the overall complication rate between the two groups.Owing to the limitations of sample size and quality of the included studies,the conclusion still needs to be verified by large sample size and high-quality

关 键 词：心腔内超声心动图 经食管超声心动图 左心耳封堵术 META分析 系统评价 

分 类 号：R541.75[医药卫生—心血管疾病]