β受体阻滞剂应用于小儿充血性心力衰竭的系统评价与Meta分析  

Effects of beta-blockers for congestive heart failure in pediatric patients:Meta-analysis

作　　者：王亚丹[1] 李辉[2] 刘金平 张坤贤 赵国艳[1] WANG Yadan;LI Hui;LIU Jinping;ZHANG Kunxian;ZHAO Guoyan(Department of Operating Room,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Cardiovascular Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院手术室,武汉430071 [2]武汉大学中南医院心血管外科,武汉430071

出　　处：《中国药师》2024年第2期345-356,共12页China Pharmacist

基　　金：国家自然科学基金面上项目(82170505)。

摘　　要：目的 系统评价β受体阻滞剂对小儿充血性心力衰竭患者的疗效,为临床用药提供证据。方法 从PubMed、Embase、the Cochrane Library及CNKI、万方、维普数据库中检索相关前后对照试验与随机对照试验,检索时限自建库起至2023年10月31日。结局指标有左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、N端B型脑钠肽(NT-proBNP)、心率、血压及心功能改善情况。结果 共纳入20项符合标准的研究,包含1 068例患儿,包括扩张型心肌病、心内膜弹力纤维增生。Meta分析显示,在常规心力衰竭药物治疗的基础上,使用β受体阻滞剂(琥珀酸美托洛尔、比索洛尔及卡维地洛),对改善患儿LVEF[MD=13.06,95%CI(11.67,14.45),P <0.001]、LVFS [MD=6.96,95%CI(6.54,7.37),P <0.001]、LVDD [MD=-6.43,95%CI(-7.58,-5.28),P <0.001]和LVSD [MD=-8.30,95%CI(-8.83,-7.76),P <0.001]效果显著;也可改善患儿血压、心率、NT-proBNP和心功能。结论 在常规心力衰竭药物治疗的基础上使用β受体阻滞剂的联合方案可提高小儿充血性心力衰竭患者的心功能及改善心力衰竭症状,推荐将β受体阻滞剂积极应用于该类患儿的常规治疗方案中。Objective To systematically evaluate the efficacy ofβ-blocker in pediatric patients with congestive heart failure and congenital heart disease,and to provide evidence for clinician.Methods Before-and-after self-control study and randomized controlled trials were retrieved from PubMed,EMbase,the Cochrane Library,CNKI,WanFang,VIP databases,and the search time was from the establishment of the database to October 31,2023.All outcomes included left ventricular ejection fraction(LVEF),left ventricular fraction shortening,LVFS),left ventricular end-diastolic dimension(LVDD),Left ventricular end-systolic dimension(LVSD),N-terminal proB brain natriuretic peptide(NT-proBNP),heart rate,blood pressure and cardiac function improvement.Results A total of 20 trials involving 1068 children with heart failure(dilated cardiomyopathy and endocardial fibroelastosis were included.Meta-analysis results showed that the addition ofβ-blockers(metoprolol succinate,bisoprolol and carvedilol)on the basis of conventional drug therapy for heart failure had significant effects on LVEF[MD=13.06,95%CI(11.67,14.45),P<0.001],LVFS[MD=6.96,95%CI(6.54,7.37),P<0.001],LVDD[MD=-6.43,95%CI(-7.58,-5.28),P<0.001]and LVSD[MD=-8.30,95%CI(-8.83,-7.76),P<0.001]were significantly improved.In addition,blood pressure,heart rate,NT-proBNP and cardiac function could also be improved.Conclusion The combination regimen ofβ-blockers on the basis of conventional drug therapy for heart failure can improve cardiac function and symptoms of heart failure in children with congestive heart failure.Therefore,it is recommended thatβ-blockers should be actively used in the conventional treatment regimen for children with congestive heart failure.

关 键 词：充血性心力衰竭 儿童 Β受体阻滞剂 左心室射血分数 META分析 

分 类 号：R725.4[医药卫生—儿科]