兰州大学机构库 >学院待认领
药物防治冠脉内支架植入术后无再流的安全性和有效性的系统评价
Alternative TitleThe safety and effectiveness of medication to prevent /treat no reflow after coronary stent implantation : a meta-analysis
张小卫
Thesis Advisor白锋
2011-05-12
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword无再流 冠状动脉介入治疗 随机对照试验 系统评价
Abstract第一部分 药物预防冠脉内支架置入术后无再流的安全性和有效性的系统评价 目的 多种药物已在临床用于冠脉支架术后无再流的预防,但各自的疗效尚存在一定的争议。本研究旨在系统评价药物预防冠脉内支架置入术后慢血流/无再流的临床疗效与安全性。 方法 计算机检索Cochrane图书馆的Cochrane对照试验注册数据库(2009年第1期),PubMed(1966-2009.1),MEDLINE,EMBASE(1900-2009.1),CBM (1978-2009.2),CNKI(1994-2009.2),VIP(1989-2009.2),万方数据资源(1979-2009.2)。纳入有关冠脉支架后无再流的药物预防的随机对照试验,无论是否采取盲法,按照Cochrane Handbook 5.0.2手册推荐的方法,有两名评价员独立提取如下信息:纳入研究的基本信息、患者基线资料、干预措施、观察指标、失访和是否进行意向分析等,并交叉核对纳入研究的质量,对同质研究采用RevMan5.0软件进行Meta-分析,异质性过大的资料则采用描述性分析。纳入研究的方法学的质量主要从以下几个方面进行评估:随机方法是否正确或是否充分、分配隐藏是否正确或是否充分、采取的盲法是否有效、是否存在不完整数据的报道和采取意向分析(ITT)等。 结果 依据纳入和排除标准,本研究共纳入21个随机对照试验(RCTs),包括1960例患者。Meta-分析显示:冠脉内注射腺苷、地尔硫卓、尼可地尔可明显减少无再流/慢血流的发生,而冠脉内注射乌拉地尔却没有意义。静脉注射尼可地尔、替罗非班可明显减少无再流/慢血流的发生,而孟替普酶却没有此效果。冠脉注射替罗非班,冠脉和静脉注射尼可地尔可以改善CTFC(校正的TIMI帧数),而冠脉注射硝普钠,CTFC却未见改善。冠脉内注射奈替普酶、腺苷和静脉内注射尼可地尔均可提高TIMI,但冠脉内注射替罗非班和硝普钠却未见此效果。静脉内注射尼可地尔可以增加LVEF(左心室射血分数),而冠脉内注射维拉帕米却未见此效果。冠脉内注射奈替普酶增加了出血并发症的发生率,而静脉内注射替罗非班却没有增加出血并发症。静脉内注射尼可地尔可以有效地减少室颤、室速等并发症,冠脉内注射孟提普酶却没有。冠脉内注射奈替普酶,地尔硫卓,腺苷,静脉内注射尼可地尔,均没有减少术后死亡率。 结论 研究结果显示冠脉内注射腺苷、地尔硫卓、尼可地尔和静脉注射尼可地尔、替罗非班都可以起到预防无再流/慢血流的效果,而在提高左室射血分数和减少术后不良反应方面,尼可地尔可以获得较好的效果,但是限于纳入研究在方法学方面的局限性,尚需要开展大样本、高质量的RCT进一步论证其疗效和安全性。 关键词:无再流 冠状动脉介入治疗 随机对照试验 系统评价 第二部分 药物治疗冠脉内支架植入术后无再流的安全性和有效性的系统评价 目的 系统评价药物治疗冠脉内支架置入术后无再流的有效性和安全性。 方法 计算机检索 Cochrane 图书馆的Cochrane 对照试验注册数据库(2009 年第 2 期)、PubMed、 MEDLINE、 EMbase、 CBM、CNKI、 VIP、万方数据资源 (截至 2009 年 4 月)。由 2 名评价者独立评价并交叉核对纳入研究的质量,对同质研究采用RevMan 5.0软件进行Meta分析。 结果 根据纳入和排除...
Other AbstractPartⅠ The safety and effectiveness of medication to prevent no reflow:a meta-analysis Objective To evaluate the clinical efficacy and safety of coronary artery medication injection to prevent slow flow/no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), PubMed(1966-2009.1), Embase(1900-2009.1), CBM(1978-2009.2), CNKI(1994-2009.2), VIP(1989-2009.2), Wanfang database(1979-2009.2), et al from their inception to February,2009. All the randomized,placebo-controlled trials (RCTs) about drug prevention for no reflow will be included regardless of blinding. According to the assessment method provided by Cochrane handbook 5.0.2, two searchers extracted information of included literatures independently: Two reviewers independently evaluated the quality of the studies and extracted the data. Meta-analysis was performed by RevMan 5.0 software. The date contained basic information of the studies, patients baseline datas, intervention measures, observing indexes, lost to follow-up and ITT , etc. The Methodological quality was estimated according :the right Randomized methods, blind methods, Allocation concealment and Intention -To-Treat et al. Results Twenty-one randomized controlled trials (RCTs) including 1960 patients were included.The result of meta-analysis showed that Intracoronary adenosin、diltiazem、nicorandil ,intravenous tirofiban、nicorandil can reduce the incidence of no reflow/slow flow, however intravenous Monteplase and intracoronary Urapidil couldn’t. Intracoronary tirofiban、nicorandil and intravenous nicorandil could improve CTFC,however Intracoronary nitroprusside couldn’t improve CTFC,Intracoronary adenosine and TNK,intravenous nicorandil could improve TIMI3, however intravenous tirofiban and intracoronary nitroprusside couldn’t. intravenous nicorandil could improve LVEF ,but Intracoronary Verapamil could’t. Intravenous tirofiban didn’t rise the incidence of the bleeding complication,but intravenous monteplase did. IntravenousNicorandil could reduce the incidence of VT/VF, but intravenous Monteplase couldn’t.All drugs didn’t reduce the incidence the death rate. Conclusion Evidences show that adenosin、diltiazem、nicorandil tirofiban could prevent no reflow/slow flow , monteplase and Urapidil could’t, However nicorandil also could improve LVEF and reduce complication such as VT/VF. there is a m...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222384
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
张小卫. 药物防治冠脉内支架植入术后无再流的安全性和有效性的系统评价[D]. 兰州. 兰州大学,2011.
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