早期静脉应用β受体阻滞剂对急性心肌梗死患者预后影响的Meta分析

The effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction:a Meta analysis

目的：系统评价再灌注时心肌梗死后早期静脉应用β受体阻滞剂对患者预后的影响。方法检索Pubmed、Embase、Cochrane 图书馆、中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库，收集比较再灌注背景下心肌梗死后早期静脉使用β受体阻滞剂（试验组）不使用或者使用安慰剂（对照组）对患者预后影响的研究。主要观察指标为短期及长期的全因病死率及恶性心律失常、心肌再梗死、心源性休克等发生率。采用Revman5．2软件对提取的数据进行荟萃分析。结果纳入8项临床研究，共48367例患者。 Meta分析显示，试验组与对照组相比，心肌梗死患者恶性室性心律失常发生率下降（OR＝0．83，95％CI 0．75～0．93， P ＝0．0009）；心源性休克、心力衰竭发生率增加（OR＝1．29，95％CI 1．18～1．41， P ＜0．01），2组心肌梗死患者全因病死率、再梗死、缺血等不良事件发生率差异无统计学意义（OR＝0．98 ，95％CI 0．92～1．05， P ＝0．63；OR＝0．95 ，95％CI 0．88～1．03， P ＝0．21）。结论在心肌梗死早期静脉给予β受体阻滞剂可以降低梗死后恶性室性心律失常发生率，但同时也有增加心源性休克、心力衰竭发生的风险，在改善病死率方面没有明显获益。

Objective To evaluate the effect of early intravenous beta blockers on prognosis in patients with acute myocardial infarction（ AMI） .Methods Searched on PubMed, Embase, Cochrane library, CNKI, Wanfang Data,VIP journal resources integration service platform, the Chinese biomedical literature database, collected and compared AMI reperfusion pa-tients received early intravenous beta blockers （ test group） and does not use beta blockers or placebo （ control group） to study the impact on prognosis.Main outcome measurements included short-term and long-term all-cause mortality and malignant ar-rhythmia,myocardialinfarction,cardiogenicshockincidence.UsingtheRevman5.2softwaretoextractthedata.Results 8 studies with 48 367 patients were enrolled.Meta-analysis showed that, compared to the control group, experimental group’ s myocardial infarction malignant ventricular arrhythmia incidence decreased （ OR=0.83, 95% CI 0.75-0.93, P =0.000 9）;cardiogenic shock, heart failure incidence increased （OR=1.29, 95% CI 1.18 -1.41, P〈0.01）;2 groups’ all-cause mortality, re-myocardial infarction, ischemic adverse events rates were showed no statistically significant （ OR=0.98, 95%CI 0.92-1.05, P =0.63;OR=0.95, 95%CI 0.88-1.03, P =0.21）.Conclusion In early stage of AMI, intra-venous beta blockers can reduce infarction related malignant ventricular arrhythmia rate, but also increase the risk of heart fail-ure, cardiogenic shock, there is no obvious benefit in the aspects of decreasing mortality rate.