CAJ | 학술논문

目的：系统评价易化PCI与直接PCI治疗急性心肌梗死疗效和安全性的差异。方法检索1990年1月～2012年12月Cochrane图书馆、PUBMED、生物医学文献数据库、万方数据库，以急性心肌梗死为研究对象，比较易化PCI与直接PCI治疗效果的随机对照试验或临床对照试验文献，并对研究结果采用RevMan4.2软件进行Meta分析。结果共纳入17项研究结果，包括1498例患者。Meta分析结果显示：①与直接PCI组相比，易化PCI组的术前梗死相关动脉（IRA）开通率明显较高（OR=3.51，95%CI：2.60～4.73），尤其是达TIMI3级血流IRA（OR=4.31，95%CI：2.88～6.45）；②住院死亡率（OR=1.14，95%CI：0.50～2.61）、心脏事件发生率（OR=1.05，95%CI：0.60～1.84）、无复流现象比较（OR=0.41，95%CI：0.13～1.30），两组差异无统计学意义；③易化PCI组改善左室射血分数明显高于直接PCI组（WMD=4.89，95%CI：1.49～7.44）。结论目前证据表明，对不能直接PCI治疗的AMI患者，规范的易化PCI治疗是安全的，且对患者远期心功能的改善有获益。但鉴于纳入文献整体质量偏低，对易化PCI溶栓药物及溶栓后行PCI时间的选择等方面尚需进一步的研究。
목적：계통평개역화PCI여직접PCI치료급성심기경사료효화안전성적차이。방법검색1990년1월～2012년12월Cochrane도서관、PUBMED、생물의학문헌수거고、만방수거고，이급성심기경사위연구대상，비교역화PCI여직접PCI치료효과적수궤대조시험혹림상대조시험문헌，병대연구결과채용RevMan4.2연건진행Meta분석。결과공납입17항연구결과，포괄1498례환자。Meta분석결과현시：①여직접PCI조상비，역화PCI조적술전경사상관동맥（IRA）개통솔명현교고（OR=3.51，95%CI：2.60～4.73），우기시체TIMI3급혈류IRA（OR=4.31，95%CI：2.88～6.45）；②주원사망솔（OR=1.14，95%CI：0.50～2.61）、심장사건발생솔（OR=1.05，95%CI：0.60～1.84）、무복류현상비교（OR=0.41，95%CI：0.13～1.30），량조차이무통계학의의；③역화PCI조개선좌실사혈분수명현고우직접PCI조（WMD=4.89，95%CI：1.49～7.44）。결론목전증거표명，대불능직접PCI치료적AMI환자，규범적역화PCI치료시안전적，차대환자원기심공능적개선유획익。단감우납입문헌정체질량편저，대역화PCI용전약물급용전후행PCI시간적선택등방면상수진일보적연구。
Objective To review systematically the difference in curative effects and safety between facilitated PCI and primary PCI in the treatment of acute myocardial infarction (AMI). Methods The databases of Cochrane Library, PubMed, CBM and WangFang Database were retrieved for collecting randomized controlled trials (RCT) or clinical controlled trials (CCT) about the curative effects of facilitated PCI and primary PCI taken AMI as research objects. The outcomes were compared and given Meta-analysis by using RevMan4.2 software. Results There were totally 17 RCT included involving 1498 cases, and the results of Meta-analysis showed as follows:①Compared with primary PCI group, the patency rate of infarction related artery (IRA) before PCI was significantly higher in facilitated PCI group (OR=3.51, 95%CI:2.60-4.73), especially the TIMI 3 flow of IRA (OR=4.31, 95%CI:2.88-6.45). ②There were no statistical differences in mortality, incidence of cardiac events and no-reflow during hospitalization between two groups (OR=1.14, 95%CI:0.50-2.61;OR=1.05, 95%CI:0.60-1.84;OR=0.41, 95%CI:0.13-1.30). ③The amelioration of left ventricular ejection fraction (LVEF) was much better in facilitated PCI group than that in primary PCI group (WMD=4.89, 95%CI:1.49-7.44). Conclusion Facilitated PCI is safe and has better curative effect in the treatment of AMI compared with primary PCI indicated by current data. Because the quality of total included RCT is lower, more RCT with higher quality are required for further identifying the results.