β受体阻滞剂预防心脏手术后心房颤动效果的网状Meta分析  

Efficacy ofβ-blockers in the prevention of postoperative atrial fibrillation after cardiac surgery:A network meta-analysis

作　　者：余朗轩 谭子祎 李锦妍 王小文[2] 李林俊 张诚[1,3] 蒋迎九 YU Langxuan;TAN Ziyi;LI Jinyan;WANG Xiaowen;LI Linjun;ZHANG Cheng;JIANG Yingjiu(The First Clinical Faculty,Chongqing Medical University,Chongqing,400016,P.R.China;Department of Cardiothoracic Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China;Department of Cardiothoracic Surgery ICU,The First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China)

机构地区：[1]重庆医科大学第一临床学院,重庆400016 [2]重庆医科大学附属第一医院胸心外科,重庆400016 [3]重庆医科大学附属第一医院胸心外科ICU,重庆400016

出　　处：《中国胸心血管外科临床杂志》2024年第6期891-899,共9页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：重庆医科大学附属第一医院青年拔尖科技人才项目(BJRC2020-05)。

摘　　要：目的比较不同β受体阻滞剂预防心脏外科术后心房颤动(postoperative atrial fibrillation,POAF的效果差异。方法计算机检索PubMed、Science Direct、Web of Science、The Cochrane Library、中国生物医学文献数据库、中国知网、万方和维普数据库,收集比较不同β受体阻滞剂预防心脏外科POAF的随机对照研究,检索时限从建库至2022年4月31日。由两名研究者独立筛选文献并提取资料。采用Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用RevMan 5.3和STATA 17.0软件进行Meta分析。结果最终共纳入17项随机对照研究,共3290例患者。直接Meta分析结果显示:在预防POAF发生方面,兰地洛尔、美托洛尔的效果优于安慰剂(P≤0.001),卡维地洛的效果优于美托洛尔(P<0.001)。网状Meta分析结果显示:与安慰剂相比,兰地洛尔、卡维地洛、美托洛尔预防POAF的效果更好;与美托洛尔相比,兰地洛尔、卡维地洛预防效果更好;与奈必洛尔相比,卡维地洛的效果更好(P均<0.05)。6种β受体阻滞剂的优选概率排名曲线下面积值从高到低依次为:卡维地洛、兰地洛尔、普萘洛尔、阿替洛尔、美托洛尔、奈必洛尔。结论卡维地洛和兰地洛尔对预防POAF有不同程度的显著改善作用,其中卡维地洛预防效果最佳。但由于纳入研究数量与样本量总体较小,证据强度仍需更多高质量研究进一步验证。Objective To compare the effectiveness of differentβ-blockers for preventing postoperative atrial fibrillation(POAF)after cardiac surgery.Methods Databases of PubMed,Science Direct,Web of Science,The Cochrane Library,SinoMed,CKNI,VIP,WanFang were searched by the computer from inception to April 31,2022 to collect randomized controlled studies on the comparison of the effectiveness of differentβ-blockers for preventing POAF.Two investigators independently screened the literature and extracted information.The quality of the literature was evaluated using Cochrane bias risk tool,and RevMan 5.3 and STATA 17.0 were used for meta-analysis.Results A total of 17 randomized controlled studies with 3290 patients were included.Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo(P≤0.001),and carvedilol was more effective than metoprolol in preventing the development of POAF(P<0.001).Network meta-analysis showed that landiolol,carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF(P<0.05).Landiolol and carvedilol were more effective than metoprolol,and carvedilol were more effective than nebivolol(P<0.05).The surface under the cumulative ranking curve from high to low were carvedilol,landilol,propranolol,atenolol,metoprolol,and nebivolol.Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF,and carvedilol has the best preventive effect.More studies are required to verify the strength of evidence due to the limited sample size.

关 键 词：术后心房颤动 Β受体阻滞剂 心脏手术 网状Meta分析 抗心律失常药 

分 类 号：R54[医药卫生—心血管疾病]