CAJ | 학술논문

目的：系统评价血栓抽吸装置在急性ST段抬高型心肌梗死患者中的临床疗效。方法计算机检索The Cochrane Library、PubMed、EMbase、中国期刊全文数据库、万方数据库，检索急性ST段抬高型心肌梗死冠脉支架介入治疗应用血栓抽吸装置与单纯冠脉支架介入治疗的随机对照研究（RCT）。按照纳入与排除标准，由两位研究者独立进行文献筛选、资料提取和方法学质量评价后，采用RevMan5.0软件进行Meta分析。结果最终纳入22个随机对照研究，共5177例患者，研究分为抽吸组与PCI组。Meta分析结果显示抽吸组出院后主要心血管不良事件明显低于PCI组（OR=0.78，95%CI：0.62～0.99， P=0.04）。抽吸组与PCI组术后死亡率差异无统计学意义（OR=0.92，95%CI：0.65～1.31，P=0.64）,但随访时间在180天至365天抽吸组术后死亡率明显低于PCI组（OR=0.63，95%CI：0.42～0.94，P=0.02）。抽吸组术后心肌灌注3级高于PCI组（OR=2.03，95%CI：1.37～3.0，P=0.004）；术后TIMI3血流高于PCI组（OR=1.31，95%CI：1.11～1.54，P=0.001）。结论血栓抽吸装置可明显改善急性ST段抬高型心肌梗死患者术后心肌血流再灌注，降低术后180天至365天的死亡率，减少出院后主要心血管不良事件的发生。
목적：계통평개혈전추흡장치재급성ST단태고형심기경사환자중적림상료효。방법계산궤검색The Cochrane Library、PubMed、EMbase、중국기간전문수거고、만방수거고，검색급성ST단태고형심기경사관맥지가개입치료응용혈전추흡장치여단순관맥지가개입치료적수궤대조연구（RCT）。안조납입여배제표준，유량위연구자독립진행문헌사선、자료제취화방법학질량평개후，채용RevMan5.0연건진행Meta분석。결과최종납입22개수궤대조연구，공5177례환자，연구분위추흡조여PCI조。Meta분석결과현시추흡조출원후주요심혈관불량사건명현저우PCI조（OR=0.78，95%CI：0.62～0.99， P=0.04）。추흡조여PCI조술후사망솔차이무통계학의의（OR=0.92，95%CI：0.65～1.31，P=0.64）,단수방시간재180천지365천추흡조술후사망솔명현저우PCI조（OR=0.63，95%CI：0.42～0.94，P=0.02）。추흡조술후심기관주3급고우PCI조（OR=2.03，95%CI：1.37～3.0，P=0.004）；술후TIMI3혈류고우PCI조（OR=1.31，95%CI：1.11～1.54，P=0.001）。결론혈전추흡장치가명현개선급성ST단태고형심기경사환자술후심기혈류재관주，강저술후180천지365천적사망솔，감소출원후주요심혈관불량사건적발생。
Objective To review systematically the curative effect of thrombus aspirator on acute ST-segment elevation myocardial infarction (STEMI). Methods The databases of Cochrane Library, PubMed, Embase, CNKI and WangFang Database were retrieved with computer for collecting randomized controlled trials (RCT) about thrombus aspirator application during percutaneous coronary intervention (PCI) and simple PCI treatment in the patients with STEMI. All RCT were selected by two researchers independently according to inclusion and exclusion criteria, and data was extracted and given methodological quality evaluation. The Meta-analysis was conducted by using RevMan 5.2 software. Results There were totally 22 RCT included involving 5177 cases, who were divided into aspirator group and PCI group. The results of Meta-analysis showed that the incidence of major adverse cardiovascular events (MACE) after discharged from hospital was significantly lower in aspirator group than that in PCI group (OR=0.78, 95%CI:0.62-0.99, P=0.04). The mortality after PCI was not statistically significant between two groups (OR=0.92, 95%CI:0.65-1.31, P=0.64), but was significantly lower in aspirator group than that in PCI group during follow-up from 180 d to 365 d (OR=0.63, 95%CI:0.42-0.94, P=0.02). Myocardial perfusion (grade 3) after PCI (OR=2.03, 95%CI:1.37-3.0, P=0.004), and TIMI3 after PCI (OR=1.31, 95%CI:1.11-1.54, P=0.001) were higher in aspirator group than those in PCI group. Conclusion Thrombus aspirator can significantly ameliorate myocardial reperfusion after discharged from hospital, and reduce mortality from 180 d to 365 d after PCI and incidence of MACE in the patients with STEMI.