远程缺血预处理对行经皮冠状动脉介入术后患者心肌保护作用的Meta分析

Protective effect of remote ischemic preconditioning on myocardium in patients with percutaneous coronary intervention: a Meta-analysis

目的评价远程缺血预处理(RIPC)对经皮冠状动脉介入(PCI)术患者术后心肌保护的效果。方法计算机检索Pub Med、Web of Science、Cochrane Library数据库中有关RIPC对PCI手术后成年患者心肌保护作用的随机对照试验。干预措施为RIPC组给予数次上肢或下肢的缺血再灌注预处理,对照组无任何缺血预处理。主要观察指标为PCI术后主要心血管事件(MACE)、心肌梗死及不同部位RIPC后MACE的发生率。采用Rev Man5.2软件进行Meta分析。结果 11篇文献纳入研究,其中RIPC组961例,对照组951例。Meta分析显示RIPC组MACE、心肌梗死发生率明显低于对照组(P<0.05);在上肢的RIPC与下肢的RIPC的亚组分析中,两组的术后MACE发生率均低于对照组(P<0.05)。结论RIPC可以减少PCI患者术后MACE、心肌梗死的发生率,对心肌有明显的保护作用。

Objective To evaluate the postoperative effect of remote ischemic preconditioning（ RIPC） on the protection of myocardium in patients undergoing percutaneous coronary intervention（ PCI）. Methods The computer retrieve was performed in the databases of Pub Med,Wed of Science and Cochrane Library for randomized controlled trials（ RCTs） about the protective effect of RICP on myocardium in adults with PCI. The invention of RIPC group was several ischemia-reperfusion preconditioning of upper or lower extremities,and control group without any ischemic preconditioning. The primary indices were incidences of major adverse cardiovascular events（ MACE） after PCI,myocardial infarction and MACE after RIPC for different parts of the body. A Meta-analysis was conducted using Rev Man5. 2software. Results A total of 11 studies were enrolled,of which 961 cases were in the RIPC group and 951 cases in the control group. The Meta-analysis showed that the incidences of MACE and myocardial infarction in the RIPC group were significantly lower than those in the control group（ P 〈 0. 05）. In a subgroup analysis of RIPC for upper extremities and lower extremities,the incidences of postoperative MACE in both subgroups were lower than the incidence in the control group（ P 〈 0. 05）. Conclusion RIPC can reduce the postoperative incidences of MACE and myocardial infarction in patients with PCI,and has a significant protective effect on myocardium.