右室流出道起搏对心功能影响的Meta分析

Right Ventricular Outflow Tract Pacing for Heart Function:A Meta-analysis

目的系统评价右室流出道起搏对心功能的影响。方法计算机检索Cochrane图书馆(2008年第4期)、PubMed、EMbase,同时检索CBM、CNKI、VIP和万方数据库,检索时间截至2010年1月,收集右室流出道(RVOT)起搏与右室心尖部(RVA)起搏比较对心功能影响的随机对照试验(RCT),并按Cochrane协作网推荐的方法进行质量评价、资料提取和Meta分析。结果共纳入16个RCT,包括926例患者。Meta分析结果显示:①左室射血分数:RVOT组在3个月和18个月的左室射血分数均高于RVA组,差异有统计学意义[WMD=3.53,95%CI(1.02,6.04);WMD=8.94,95%CI(7.35,10.52)]。②QRS波时限:术后即时RVOT组和RVA组相比,QRS波时限有所减小,差异有统计学意义[WMD=–22.42,95%CI(–31.05,–13.80)],然而3个月后差异无统计学意义[WMD=–13.88,95%CI(–29.75,2.00)]。③起搏参数:RVOT组在术后即时的起搏阈值(V)高于RVA组,而3个月后,与RVA组无差别。在感知阈值和阻抗方面,即时和术后3个月时两者之间均无差异。结论相对于心尖部起搏,虽然短期内右室流出道起搏可以提高心脏功能,但长期结果仍有待于观察。限于目前研究对右室流出道起搏的长期结果报道不足,仍然需要大样本、多中心随机对照试验进一步证实右室流出道起搏的优越性。

Objective To systematically evaluate the clinical effectiveness of right ventricular outflow tract （RVOT） pacing for heart disease. Methods We searched the electronic bibliographic databases, including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI, and WANFANG database to assemble the randomized controlled trials （RCTs） of RVS Pacing compared with right ventricular apical （RVA） pacing for heart disease. The deadline of the retrieval time was January 2010. Data were extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used for meta-analysis. Results A total of 16 RCTs involving 926 patients were included. The results of meta-analyses showed that right ventricular outflow tract （RVOT） pacing significantly increased the left ventricular ejection fraction of 3 months and 18 months （WMD= 3.53, 95%CI 1.02 to 6.04; WMD= 8.94, 95%CI 7.35 to 10.52）.Compared with RVA pacing, RVOT pacing could significantly reduce the QRS wave duration （WMD= –22.42, 95%CI –31.05 to – 13.80） immediately after the operation. Conclusion RVOT pacing can give patients a good physiological state which is more consistent with biventricular electric conduction and lead to the hemodynamic improvement in the short term, but the long-term result is not confident.