急性心肌梗死院前溶栓治疗的Meta分析

Prehospitai thrombolysis in acute myocardia infarction：a meta-analysis

目的 本研究应用Meta分析方法对多个急性心肌梗死院前溶栓治疗的临床研究进行综合分析和评价,以期找到科学的证据指导临床治疗.方法 检索1989年1月至2009年4月在国内外公开发布的关于急性心肌梗死院前溶栓治疗的文献,以冠状动脉再通率、并发症发生率、短期（＜30d）死亡率作为效应指标,应用RevMan4.2.8软件进行Meta分析.结果 Meta分析结果显示,院前溶栓组冠脉再通率优于院内溶栓组[OR 2.67,P＜0.01],短期（＜30 d）死亡率低于院内溶栓组[OR 0.71,P＜0.01],两者在并发症发生率上差异无统计学意义[OR 0.84,P=0.94].与PCI组相比,院前溶栓组并发症发生率高于PCI组[OR 2.91,P=0.005],短期（＜30 d）死亡率两者差异无统计学意义[OR 1.11,P=0.56],但其存在发表偏倚,敏感性相对差,院前溶栓疗效与预后均优于院内溶栓,而并发症发生率无明显增加,是一种安全有效的治疗方法,具有显著的临床意义.结论 与PCI相比,院前溶栓疗效及预后与PCI相当,但并发症发生率较高,但因存在发表偏倚,敏感性相对差,仍需要更多高质量的研究来进一步证实.

Objective A meta-analysis of clinical trials of prehospital thrombolysis versus in-hospital thrombolysis or PCI for acute myocardia infarction （AMI）. Method We collected the literature on prehospital thrombolysis for AMI published at home and ＂abroad from January 1989 to April 2009. Recanalization rate of infarct-related arter, complication incidence and mortality （ 〈 30 d） were regarded as result indicators. Software RevMan 4.2.8 was used to process mesa-analysis. Results There were only 27 literatures selected. Prehospital thronmbolysis was associated with higher recanalization rate of infarct-related arter [ OR 2.67,95%CI（ 1.86 - 3.85）;P 〈 0.01 ] and lower mortality （ 〈 30 d） [ OR 0.71,95 % CI（0. 64-0.78） ; P 〈 0.01 ] than in-hospital thrombolysis. There was no significant difference in complications between them. Compared with PCI, prehospital thrombolysis was associated with higher complication incidence [ OR 2.91,95 % CI （ 1.26 - 3.80） ; P = 0. 005 ]. There was no significant statistical difference of mortality （ 〈 30 d）, but the sensitivity analysis was not good. Conclusions The effect and prognosis of prehospital thrombolytic are superior to that of in-hospital thrombolysis, and the same with PCI, but prehospital thrombolytie has higher incidences of complieations, and the sensitivity is not good.