作　　者： (李琴）; (谭俊峰）; (凌波）; (王真）; (曹公兴）; (张明玺）;

机构地区： 湖北省丹江口市第一医院,丹江口442700

出　　处： 《内科急危重症杂志》 2017年第4期304-308,共5页

摘　　要： 目的:评价急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)时直接支架术(DS)和球囊预扩张后支架术(CS)2种介入方法的有效性及安全性。方法:采用计算机检索国内外的数据库,选取有中英文关于冠脉内直接支架术和预扩张支架术的临床研究,检索时间从建库截至2016年4月。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取,采用Cochrane协作网提供的RevMan5.3统计软件进行Meta分析。以治疗方法直接PCI术与预扩张PCI术为标准分组。结果:经筛选后共纳入文献13篇,其中,4项为随机对照试验,8项研究进行了临床随访,包括9 090例患者,其中,DS组2 765例(30.4%),CS组6 325例(69.6%)。Meta分析结果显示:DS组患者介入术后院内和术后30 d主要心脏事件(MACE)的发生率明显低于CS组(P<0.05);CS组患者PCI术中无复流的发生率较DS组更高(P<0.05);CS组患者PCI术后1年病死率明显高于DS组(5.86%vs 2.51%,OR=2.47,95%CI:1.76~3.48,P<0.00001)。结论:在ACS患者行PCI术中,DS较CS治疗成功率更高,并发症更低,近期临床疗效较好。 Objective： To evaluate the efficacy and safety of direct stenting（ DS） vs. conventional stenting（ CS） for patients with acute coronary syndrome（ ACS）. Methods： A search was retrieved from Pubmed,EMbase,Cochrane Library,Chinese Journal Full-text Database（ CNKI）,Chinese Biomedical Literature Database（ CBM）,Chinese Science and Technology Periodical Database（ VIP） to systematically collect the randomized controlled trials（ RCTs） of DS vs. CS for the patients with ACS undergoing PCI from inception to April 2016. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality of included studies. Meta-analysis was performed using RevMan 5. 3 software. Results： Thirteen studies involving 9090 patients met the inclusion criteria. Of these,there were 4 RCTs,and 8 had the follow-up results. The results of meta-analysis showed that the incidence of major adverse cardiovascular events（ MACE） within 30 days（ OR = 1. 65,95% CI： 1. 25 ~ 2. 18,P = 0. 0004） was significantly higher in the patients by CS strategy than in those by DS strategy. The no-reflow phenomenon in PCI procedure was significantly higher in the CS group than in the DS group（ OR = 1. 96,95% CI： 1. 29 ~ 2. 97,P = 0. 002）. Also,the 1-year mortality was significantly increased in the CS group as compared with the DS group. Conclusion： As compared with CS,DS can be more safe and effective for patients with ACS. However,this conclusion still needs to be confirmed by well-designed and large scale RCTs with longer follow-up duration.

关 键 词： 直接支架术 预扩张支架术 急性冠脉综合征 经皮冠状动脉介入治疗 分析