胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的Meta分析

Amiodarone for Repurfusion Arrhythmia ater hrombolytic herapy for Acute Myocardial Infarction:A Meta-Analysis

目的系统评价胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的疗效,为合理制定急性心肌梗死溶栓治疗方案提供高质量证据。方法计算机检索PubMed、EMbase、he Cochrane Library(2012年第3期)、CBM、CNKI、VIP及WanFang Date数据库,全面收集胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的随机对照试验(RCT),检索时限均为建库至2013年1月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入5个RCT,440例患者。Meta分析结果显示:与空白对照组比较,胺碘酮组可降低急性心肌梗死溶栓术后RA的总发生率[RR=0.60,95%CI(0.48,0.74),P<0.000 01]和室颤发生率[RR=0.47,95%CI(0.26,0.85),P=0.01],且不影响溶栓术后冠脉再通率[RR=1.00,95%CI(0.88,1.15),P=0.94],但不能降低术后病死率[RR=0.33,95%CI(0.10,1.09),P=0.07]。结论现有证据表明,胺碘酮能降低急性心肌梗死溶栓术后再灌注心律失常发生率,但未能降低病死率。受纳入研究质量和数量限制,上述结论尚需更多高质量RCT结果加以验证。

Objective To systematically review the effectiveness of amiodarone in treating repurfusion arrhythmia （RA） after thrombolytic therapy for acute myocardial infarction （AMI）, so as to provide high quality evidence for formulating the rational thrombolytic therapy for AMI. Methods Randomized controlled trails （RCTs） on amiodarone in treating RA after thrombolytic therapy for AMI were electronically retrieved in PubMed, EMbase, The Cochrane Library （Issue 3, 2012）, CBM, CNKI, VIP and WanFang Data from inception to January, 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed quality. Then RevMan 5.1 software was used for meta-analysis. Results A total of 5 RCTs involving 440 patients were included. The results of meta-analysis suggested that, compared with the blank control, amiodarone reduced the incidence of RA after thrombolytic therapy in treating AMI （RR=0.60, 95%CI 0.48 to 0.74, P〈0.000 01） and the incidence of ventricular fibrillation （RR=0.47, 95%CI 0.26 to 0.85, P=0.01）. It neither affected the recanalization rate of occluded arteries after thrombolytic therapy （RR=1.00, 95%CI 0.88 to 1.15, P=0.94） nor decreased the mortality after surgery （RR=0.33, 95%CI 0.10 to 1.09, P=0.07）. Conclusion Current evidence indicated that, amiodarone can decrease the incidence of RA. Unfortunately, the mortality rate can’t be reduced by amiodarone. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion