硝酸甘油与异丙肾上腺素在直立倾斜试验中应用效果的Meta分析  

Meta-analysis of the application effect of nitroglycerin and isoproterenol in head-up tilt test

作　　者：党林林 舒婷婷 曹敏 褚嫒嫒[1] Dang linlin;Shu tingting;Cao min;Chu aiai(Gansu Provincial Hospital,Lanzhou,730000,China)

机构地区：[1]甘肃省人民医院,730000

出　　处：《临床心电学杂志》2025年第1期13-17,22,共6页Journal of Clinical Electrocardiology

基　　金：甘肃省自然科学基金资助项目(编号:21JR7RA604);甘肃省人民医院国自然培育基金(编号:19SYPYB-2)。

摘　　要：目的在直立倾斜试验的第二阶段药物激发试验中,临床上常用的药物有硝酸甘油或者异丙肾上腺素,舌下含服硝酸甘油(NTG)的直立倾斜试验,使用异丙肾上腺素(ISO)的直立倾斜试验,本文的研究目的就上述两种药物的应用效果进行比较。方法应用电脑对常用的数据库进行文献检索,包括:EMbase、PubMed、Web of Science、Cochrane Library及四个中文数据库,搜集与硝酸甘油、异丙肾上腺素及直立倾斜试验有关的临床研究,检索时间范围均为建库至2023年6月9日,采用Rev Man 5.4软件来进行Meta分析。结果总共纳入了14个临床研究,共2506例有晕厥病史的患者作为研究对象。Meta分析结果示:NTG组与ISO组在诱发阳性反应上无显著差异[OR=1.1,95%CI(0.66,1.84),P=0.7];NTG组与ISO组在出现阳性反应时间[MD=1.71,95%CI(1.19,2.24),P<0.00001]、试验总时长[MD=-23.30,95%CI(-37.08,-9.52),P=0.0009]、不良反应[OR=0.19,95%CI(0.10,0.37),P<0.00001]比较,有统计学差异。结论硝酸甘油与异丙肾上腺素在诱发阳性率上无统计学区别,但异丙肾上腺素整体试验耗费时间较长,给药方式复杂、且药物不良反应多见。Objective In the second phase of the head-up tilt test drug induced test,commonly used drugs in clinical practice are nitroglycerin(NTG)or isoproterenol(ISO).The purpose of this study is to compare the application effects of these two drugs.Methods Using computers to conduct literature searches on commonly used databases,including EMbase,PubMed,Web of Science,Cochrane Library,and four Chinese databases,to collect clinical studies related to nitroglycerin,isoproterenol,and head-up tilt test.The search time was from the establishment of the database until June 9,2023,and meta-analysis was conducted using Rev Man 5.4 software.Results A total of 14 clinical studies were included,with a total of 2506 patients with a history of syncope as the study subjects.The meta-analysis results showed that there was no significant difference between NTG group and ISO group in inducing positive reactions[OR=1.1,95%CI(0.66,1.84),P=0.7];There were statistical differences between NTG group and ISO group in terms of positive reaction time[MD=1.71,95%CI(1.19,2.24),P<0.0001],total trial time[MD=-23.30,95%CI(-37.08,-9.52),P=0.0009],and adverse reactions[OR=0.19,95%CI(0.10,0.37),P<0.0001].Conclusions Nitroglycerin and isoproterenol demonstrated comparable efficacy in inducing positive responses during head-up tilt test,with no statistically significant difference in positive rates.However,isoproterenol was associated with prolonged procedural duration,complex administration protocols,and a higher incidence of adverse drug reactions.

关 键 词：硝酸甘油 异丙肾上腺素 直立倾斜试验 META分析 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]