摘要
目的系统评价经皮冠状动脉介入治疗ST段抬高性心肌梗死时行缺血后处理对心肌保护作用的有效性。方法计算机检索Pubmed,EMbase,Cochrane Library,VIP和Wangfang Data数据库,检索时限均为建库至2013年5月。收集关于介入治疗ST段抬高性心肌梗死行缺血后处理的临床随机对照试验(RCT),由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan 5.2.5软件进行Meta分析。结果共纳入13个研究,765例患者。Meta分析结果:与对照组比较,缺血后处理组心肌损伤程度显著下降,心肌梗死面积(IS)显著减少(WMD=-5.92,95%CI:-8.80~3.04,P<0.0001),肌酸激酶峰值下降(WMD=-341.45,95%CI:-480.62~202.28,P<0.00001);室壁运动评分指数(WMSI)降低(WMD=-0.24,95%CI:-0.27^-0.22,P<0.00001);介入治疗后长期左心室射血分数提高(WMD=7.04,95%CI:3.90~10.19,P<0.0001),而短期左心室射血分数则无显著变化(WMD=-0.73,95%CI:-1.64~0.18,P=0.12)。结论于经皮冠状动脉介入治疗中行缺血后处理能显著降低肌酸激酶峰值,提高心脏泵功能,降低梗死面积。受纳入研究质量限制和可能存在的发表偏倚影响,上述结论尚需更多高质量的随机对照试验加以验证。
Objectives To evaluate the effectiveness of ischemic postconditioning （IPO） in myocardial protection of patients with acute ST-segment elevation myocardial infarction （STEMI） receiving primary percutaneous coronary intervention （PCI）.Methods We performed searches of PubMed,Embase,Cochrane databases,VIP and Wangfang Data from date of their establishment to May 2013 to identify relevant studies,comparing IPO with usual care for patients undergoing primary PCI.Two reviewers independently screened studies according to the inclusion and exclusion criteria,extracted data and assessed the methodological quality of the included studies.Then the Meta analysis was performed by RevMan 5.2.5 software.Results A total of 13 randomized clinical trials （RCTs） involving 765 patients with STEMI were included.The results of meta analysis showed：the IPO group was significantly lower than control group in myocardial infarct size （WMD=-5.92,95％CI：-8.80-3.04,P＜0.0 001）,peak creatine kinase （WMD=-341.45,95％CI：-480.62-202.28,P＜0.00 001）,wall motion score index （WMSI） （WMD=-0.24,95％CI：-0.27-0.22,P＜0.00 001）.We also observed that the IPO group was superior to the control group in long-term left ventricular ejection fraction （LVEF） （WMD=7.04,95％CI：3.90-10.19,P＜0.0 001）,but short-term LVEF showed no significant change （WMD=-0.73,95％CI：-1.64-0.18,P=0.12）.Conclusions IPO can significantly reduce peak creatine kinase,improve cardiac pump function and reduce infarction area.Due to the limitation of the included studies,large sample size,multicenter,high quality studies are needed to verify the above conclusion.
出处
《岭南心血管病杂志》
2014年第1期30-35,共6页
South China Journal of Cardiovascular Diseases
关键词
心肌梗死
缺血后处理
介入治疗
META分析
随机对照试验
myocardial infarction
ischemic postconditioning
intervention
Meta analysis
randomized clinical trial
