摘要
目的系统评价经桡动脉与经股动脉途径行经皮冠状动脉介入术（PCI）治疗ST段抬高性心肌梗死（STEMI）疗效及安全性,为临床实践提供最佳证据。方法计算机全面检索Pub Med（1994~2014.05）、EMbase（2000~2014.05）、Cochrane Library（2012年第4期）、CBM（2004~2014.05）、CNKI（2004~2014.05）、Wanfang data（2004~2014.05）,查找经股动脉途径介入治疗STEMI的疗效及安全性的随机对照试验（RCT）。由2名评价员按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行Meta分析。结果最终共纳入13个RCT共5158例。Meta分析结果显示：与经股动脉途径组相比,经桡动脉途径组可以明显减少死亡率（2.8%vs.4.8%;OR：0.56,95%CI：0.41~0.77;P〈0.001）,主要大出血发生率（1.3%vs.2.9%;OR：0.48,95%CI：0.31~0.72;P〈0.001）,主要不良心脏事件（MACE）发生率（4.6%vs.6.8%;OR：0.64,95%CI：0.50~0.83;P〈0.001）,穿刺部位并发症（2.0%vs.5.6%;OR：0.34,95%CI：0.24~0.48;P〈0.00001）;缩短住院天数（SMD：0.64;95%CI：0.50~0.83;P〈0.05）。在手术成功率,X线曝光时间,造影剂剂量,再梗死率,脑卒中发生率,冠状动脉旁路移植术（CABG）发生率,与经股动脉组相比并无统计学差异。但经桡动脉途径介入治疗比经股动脉途径的术中穿刺时间,手术时间长,更改穿刺途径发生率较多,均存在统计学差异。结论与经股动脉行PCI术相比,经桡动脉途径治疗STEMI具有明显优势。它可明显减少STEMI患者死亡率、主要大出血发生率、MACE和穿刺部位并发症,故在严格把握适应证,提高术者的手术技能情况下,经桡动脉介入治疗STEMI是安全有效的,但其远期疗效和更全面的安全性尚需开展更多大样本、高质量的RCT加以验证。
Objective To review systematically the curative effects and safety of perradial or transfemoral percutaneous coronary interventions （PCI） on ST-segment elevation myocardial infarction （STEMI）.Methods The databases of PubMed （from 1994 to May 2014）, EMbase （from 2000 to May 2014）, Cochrane Library （No. 4 of 2012 Vol.）, CBM （from 2004 to May 2014）, CNKI （from 2004 to May 2014） and WanFang Database （from 2004 to May 2014） were retrieved with computer for searching the randomized controlled trials （RCT） about the curative effect and safety of transfemoral PCI on STEMI. All materials were given document screen, data extract and quality review by 2 reviewers according to inclusion and exclusion criteria, and then given a Meta-analysis by using RevMan5.2 software.Results There were finally 13 RCT included involving 5158 cases. The results of Meta-analysis showed that mortality （2.8%vs. 4.8%;OR： 0.56, 95%CI： 0.41~0.77;P〈0.001）, major bleeding incidence （1.3%vs.2.9%;OR： 0.48, 95%CI： 0.31~0.72;P〈0.001）, MACE incidence （4.6%vs. 6.8%;OR： 0.64, 95%CI： 0.50~0.83;P〈0.001）, puncture site complications （2.0%vs. 5.6%;OR： 0.34, 95%CI： 0.24~0.48;P〈0.00001） and hospitalization days （SMD： 0.64; 95%CI： 0.50-0.83;P〈0.05） decreased significantly in perradial PCI group compared with transfemoral PCI group. The difference in procedure success rate, X-ray exposure time, contrast agent dosage, re-infarction rate, stroke incidence and CABG rate had no statistical significance between 2 groups. The puncture time and procedure time were longer and incidence of changing puncture pathways was higher in perradial PCI group than those in transfemoral PCI group.Conclusion The perradial PCI is superior to transfemoral PCI in treatment of STEMI, and it can reduce mortality, major bleeding incidence, MACE and puncture site complications. Under the condition of fitting strictly indications and improving operators’ skills, perradial PCI is safe and effective, but the long-term
出处
《中国循证心血管医学杂志》
2015年第2期170-175,187,共7页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
国家自然科学基金(81260036)
