经皮导管介入与静脉溶栓治疗对中高危急性肺栓塞的疗效及安全性的meta分析  

The efficacy and safety of percutaneous catheter-directed interventions and intravenous thrombolysis in the treatment of high-risk and intermediate-risk acute pulmonary embolism:A meta-analysis

作　　者：刘敏[1] 陈实[1] 陈颖洁 覃伟 余伟 石奕[1] 朱紫阳[1] 李发久[1] 王小江[2] Liu Min;Chen Shi;Chen Yingjie;Qin Wei;Yu Wei;Shi Yi;Zhu Ziyang;Li Fajiu;Wang Xiaojiang(Department of Pulmonary and Critical Care Medicine,Affiliated Hospital of Jianghan University,Wuhan 430060,China;Pulmonary Vascular Research Institute of Jianghan University,Wuhan 430060,China)

机构地区：[1]江汉大学附属医院呼吸与危重症医学科,武汉430060 [2]江汉大学肺血管病研究所,武汉430060

出　　处：《国际呼吸杂志》2023年第3期353-360,共8页International Journal of Respiration

基　　金：武汉市医学科研项目(WX20D85);武汉市市属高校教研课题(2021013)。

摘　　要：目的系统评价经皮导管介入与静脉溶栓治疗对中高危急性肺栓塞的疗效及安全性。方法检索中国知网、维普数据、万方数据、PubMed、Embase、Web of Science,收集经皮导管介入溶栓与静脉溶栓治疗中高危急性肺栓塞的随机对照试验,中文检索词为"肺栓塞""肺血栓栓塞症""溶栓"和"导管介入",英文检索词为"Pulmonary embolism""Pulmonary Thromboembolism""Thrombolysis""Catheter-directed interventions"。检索时间为建库至2022年5月。2名研究者按照纳入和排除标准独立进行文献筛选、资料提取及文献质量评价。采用RevMan 5.3进行meta分析。结果最终纳入研究22项,总样本量5093例。meta分析结果显示,与静脉溶栓相比,经皮导管介入溶栓有效率更高,分别为92.83%(466/502)比77.93%(339/435)(RR=1.23,95%CI:1.16~1.31,P<0.001);患者死亡率更低,分别为8.33%(174/2088)比13.36%(323/2417)(RR=0.51,95%CI:0.30~0.87,P=0.01);出血率更低,分别为9.17%(42/458)比24.25%(105/433)(RR=0.36,95%CI:0.25~0.51,P<0.001)。2种疗法住院时间差异无统计学意义(MD=-0.13,95%CI:-0.41~0.15,P=0.37)。结论经皮导管介入治疗中高危急性肺栓塞可提高临床疗效,降低死亡率和出血风险。Objective To systematically evaluate the efficacy and safety of percutaneous catheter-directed interventions and intravenous thrombolysis in the treatment of high-risk and intermediate-risk acute pulmonary embolism.Methods All randomized controlled trials reporting percutaneous catheter-directed interventions and intravenous thrombolysis in the treatment of high-risk and intermediate-risk acute pulmonary embolism were searched in the CNKI,VIP data,Wanfang Data,PubMed,Embase and Web of Science from the establishment of the database to May 2022 using the following key words,"Pulmonary embolism""Pulmonary Thromboembolism""Thrombolysis"and"Catheter-directed interventions".Two researchers independently screened the literatures according to inclusion and exclusion criteria,extracted data and evaluated literature quality.Meta-analysis was performed with RevMan 5.3.Results Twenty-two studies were included with a total sample size of 5093 patients.Meta-analysis showed that percutaneous catheter-directed interventions had a significantly higher clinical success rate(92.83%[466/502]vs 77.93%[339/435],RR=1.23,95%CI:1.16-1.31,P<0.001),significantly lower mortality(8.33%[174/2088]vs 13.36%[323/2417],RR=0.51,95%CI:0.30-0.87,P=0.01)and significantly lower bleeding rate(9.17%[42/458]vs 24.25%[105/433],RR=0.36,95%CI:0.25-0.51,P<0.001)compared with those of intravenous thrombolysis.There was no significant difference in the length of stay between the two groups(MD=-0.13,95%CI:-0.41-0.15,P=0.37).Conclusions Percutaneous catheter-directed interventions can improve clinical efficacy,reduce the mortality and bleeding rate in both high-risk and intermediate-risk population with pulmonary embolism.

关 键 词：肺栓塞 中高危 溶栓 导管介入 META分析 

分 类 号：R563.5[医药卫生—呼吸系统]