早期心脏康复程序对经皮冠状动脉介入术后患者有效性与安全性的Meta分析

The efficacy and safety of early postoperative cardiac rehabilitation program with acute myocardial infarction patients undergoing PCI: A Meta-analysis

目的通过Meta分析的方法评价早期心脏康复程序应用于经皮冠状动脉介入术(Percutaneous Coronary Intervention,PCI)后患者的有效性与安全性。方法计算机检索Cochrane Library、PubMed、EMbase、clinical trials、中国生物医学文献(CBM)、知网(CNKI)、维普(VIP)、万方等数据库,收集所有关于早期心脏康复程序对急性心肌梗死PCI术后患者的随机对照试验。2名研究者根据纳入和排除标准独立检索、筛选文献,并评价文献资料,提取资料,使用RevMan 5.3软件进行统计处理。结果共纳入11篇随机对照试验,816例样本。Meta分析结果显示,早期心脏康复程序可提高PCI术后患者的射血分数[MD=3.60,95%CI(2.73,4.47),P<0.00001],增加峰值摄氧量[MD=1.67,95%CI(0.50,2.84),P=0.005],增加6 min步行距离[MD=102.15,95%CI(11.57,192.73),P=0.03],缩短住院时长[MD=-3.40,95%CI(-5.91,-0.90),P=0.008];对不良心血管事件的发生率无影响[MD=0.41,95%CI(0.15,1.08),P=0.07]。进一步亚组分析显示,实验组在心律失常、心力衰竭的发生率方面低于对照组(P<0.05),在复发心梗、心绞痛、死亡的发生率方面差异无统计学意义(P>0.05)。结论早期心脏康复程序能有效改善PCI术后患者心肺功能,提高其运动耐量,促进机体康复且不会增加不良心血管事件(MACE)的发生率。

Objective To systematically evaluate the efficacy and safety of early postoperative cardiac rehabilitation programs with acute myocardial infarction patients undergoing PCI. Methods The databases of Cochrane Library, PubMed, EMBASE, clinical trials, Chinese Biomedical Literature(CBM), CNKI, VIP, Wanfang, etc. were searched by computer to collect all the random contrast tests of early cardiac rehabilitation program for patients with acute myocardial infarction after PCI.According to the inclusion and exclusion criteria, two researchers independently searched and screened the literature, evaluated the literature, extracted the data, and used Revman 5.3 software for statistical processing. Results A total of 816 patients were enrolled in 11 RCTs. Compared with the control group, early postoperative cardiac rehabilitation programs can improve the ejection fraction of patients [MD=3.60, 95% CI(2.73, 4.47), P<0.001], increase peak oxygen uptake [MD=1.67, 95% CI(0.50, 2.84),P=0.005], increase the walking distance of 6 minutes [MD=102.15, 95% CI(11.57,192.73), P=0.03], shorten the length of hospital stay [MD=-3.40, 95% CI(-5.91,-0.90),P=0.008];There was no effect on the incidence of major adverse cardiovascular events [MD=0.41, 95% CI(0.15, 1.08), P=0.07]. Subgroup analysis found that the test group had lower incidence of arrhythmia and heart failure than the control(P<0.05). There was no difference in the incidence of recurrent myocardial infarction, angina pectoris, and death(P>0.05). Conclusion The current research results show that early postoperative cardiac rehabilitation programs can improve cardiopulmonary function, exercise tolerance and promote patient recovery. It will not increase the incidence of MACE.