急性ST段抬高心肌梗死患者应用缺血后适应方案的系统评价

Efficacy of ischemic postconditioning in patients with acute ST-segment elevation myocardial infarction:a system review

目的评价缺血后适应治疗急性ST段抬高心肌梗死患者减少心肌梗死面积及对主要不良心血管事件的疗效,探讨其适宜的人群及方案。方法检索Cochrane、PubMed、EMBASE、万方数据库、中国期刊全文数据库和中国生物医学文献数据库,根据纳入和排除标准筛选文献并评价、提取数据,应用RevMan 5.2和STATA 12软件分别进行Meta分析与Meta回归分析。结果共纳入临床研究24项(2222例)。发现缺血后适应能显著减少心肌梗死而积[SMD-0.35,95%CI-0.72~0.07,P<0.00001,I^2=85%,n=890]。Meta回归分析发现缺血后适应对年轻患者更能减少心肌梗死面积;操作方案60 s/60 s×4优于其他方案;在主要不良心血管事件方面差异无统计学意义(RR合并0.92,95%CI0.67~1.25,P=0.58,n=1449)。结论缺血后适应显著减少心肌梗死面积,对年轻患者更有益,且60 s/60 s×4方案效果更好,但在主要不良心血管事件方面无显著益处。

Objective This system review summarized the efficacy of ischemic postconditiong in patients with acute ST-segment elevation myocardial infarction（STEMI） and explored the suitable patients and protocol.Methods The following databases were searched,including the Cochrane Library,PubMed,EMBASE,WanFang,CNKI and CBM database.Search criteria;studies were screened and the quality was evaluated according to predefined inclusion and exclusion criteria.Data were extracted and ananlyzed by RevMan 5.2 and Statal2.Results There were total 24 clinical trials（n =2222） included.There were no significant differences of major adverse cardiac events between the ischemic postconditioning group and primary PCI group.The results showed that the decrease in infarct size in the ischemic postconditioning group was greater than that in the PCI group（SMD- 0.35,95%CI- 0.72- 0.07,P〈0.00001,I^2 =85%）.Ischemic postconditioning was found more suitable for young patients and the protocol of60 s/60 s× 4 was better than others by meta regression analysis.The major adverse cardiac events were no significant differences（RR 0.92,95%CI 0.67- 1.25,P = 0.58,n = 1449）.Conclusions Ischemic postconditioning could decrease infarct size for patients with acute STEMI.Ischemic postconditioning was suitable for young patients and the protocol of 60 s/60 s x 4 was better.There was no difference on major adverse cardiac events rates between ischemic postconditioning and primary PCI.