系统评价主动脉内球囊反搏应用时机对高危冠心病病人PCI术疗效的影响

Meta-analysis of the Efficacy of Intra-aortic Balloon Pump for High-risk Patients with Coronary Heart Disease Undergoing PCI

目的:系统评价主动脉内球囊反搏(IABP)不同置入时机对冠心病病人行PCI术疗效的影响。方法:检索中国知网、万方、维普、中国生物医学文献服务系统、the Cochrane Library、EMbase、PubMed、MedLine、Web of Science数据库,收集IABP置入时机对冠心病病人行PCI术预后影响的文献,采用RevMan 5.4.1软件进行Meta分析。结果:共纳入8项研究,Meta分析结果显示,与对照组相比,试验组IABP留置时间[MD=-17.52,95%CI(-33.84,-1.20),P=0.04]和N末端B型钠尿肽前体(NT-proBNP)水平[MD=-733.85,95%CI(-1018.06,-449.64),P<0.00001]明显低于对照组,平均动脉压[MD=9.23,95%CI(7.63,10.82),P<0.00001]、平均心率[MD=3.91,95%CI(2.05,5.77),P<0.0001]和左心室射血分数[MD=3.81,95%CI(1.36,6.26),P=0.002]明显高于对照组。结论:现有证据表明,与术中、术后被动置入IABP相比,术前预防性应用IABP改善冠心病病人PCI术围术期的临床疗效更佳,且不良反应更少。

Objective:To evaluate the efficacy of intra-aortic balloon pump(IABP)implantation for percutaneous coronary intervention(PCI)patients with coronary heart disease(CHD).Methods:We searched CNKI,Wanfang,VIP,SinoMed,the Cochrane Library,EMbase,PubMed,MedLine,and Web of Science databases to collect the literature of the application of IABP implantation for PCI patients with CHD.Meta-analysis was performed using RevMan5.4.1 software.Results:A total of 8 studies were included.The results showed that compared with the control group,the IABP indwelling time(MD=-17.52,95%CI-33.84--1.20,P=0.04)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)level(MD=-733.85,95%CI-1018.06--449.64,P<0.00001)in the observation group were significantly lower than those in the control group,and the mean arterial pressure(MD=9.23,95%CI 7.63-10.82,P<0.00001),mean heart rate(MD=3.91,95%CI 2.05-5.77,P<0.0001)and left ventricular ejection fraction(MD=3.81,95%CI 1.36-6.26,P=0.002)in the observation group were significantly better than those in the control group.Conclusion:Available evidence suggests that compared with passive placement of IABP during and after PCI,prophylactic application of IABP before PCI in patients with CHD shows better clinical efficacy and fewer adverse reactions.