CAJ | 학술논문

目的：系统评价高原性肺动脉高压的药物预防作用。方法电子检索 Cochrane 图书馆、PubMed、Else-vise、中国知网、万方数据库、维普数据库，检索时间2004年11月-2013年11月；检索语种：中文和英文。采用RevMan 5.0软件对符合纳入标准的文献采用固定效应模型或随机效应模型进行 Meta 分析。结果共纳入文献14篇，其中有关磷酸二酯酶抑制剂预防高原性肺动脉高压的文献9篇，有关波生坦的文献4篇，有关地塞米松的文献2篇，有关乙酰唑胺和银杏叶提取物的文献1篇。试验组共包括185例研究对象，安慰剂组共包括168例研究对象。14篇文献报道了药物对肺动脉压的影响，合并效应量 MD =-6.22，95% CI（-8.24，-4.20），亚组分析显示磷酸二酯酶抑制剂、地塞米松与安慰剂间差异有统计学意义〔 MD =-6.55，95% CI（-8.72，-4.37），P <0.00001；MD =-17.37，95% CI（-24.61，-10.13），P <0.00001〕，波生坦与安慰剂比较，差异无统计学意义〔 MD =-2.39，95% CI（-7.20，2.42），P =0.33〕。共5篇文献报道了对心输出量的影响，试验组和安慰剂组间差异无统计学意义〔MD =0.55，95% CI（0.10，1.01），P =0.67〕，对其进行亚组分析，磷酸二酯酶抑制剂可增加心输出量，组间差异有统计学意义〔MD =0.65，95% CI（0.14，1.16），P =0.01〕。共8篇文献报道了对血压的影响，试验组和安慰剂组间差异无统计学意义〔MD =-2.68，95% CI（-6.28，0.92），P =0.57〕。共11篇文献报道了对心率的影响，试验组和安慰剂组间差异无统计学意义〔MD =-0.67，95% CI（-6.20，4.86），P =0.81〕，进一步行亚组分析，地塞米松可增加心输出量，组间差异有统计学意义〔MD =-16.60，95% CI（-29.22，-3.99），P =0.01）〕。共10篇文献报道了对血氧饱和度的影响，试验组和安慰剂组间差异无统计学意义〔 MD =0.83，95% CI（-0.78，2.44），P =0.31〕。结论磷酸二酯酶抑制剂、地塞米松可有效预防低海拔人群暴露高原环境下肺动脉压的升高，而波生坦无效。目的：繫統評價高原性肺動脈高壓的藥物預防作用。方法電子檢索 Cochrane 圖書館、PubMed、Else-vise、中國知網、萬方數據庫、維普數據庫，檢索時間2004年11月-2013年11月；檢索語種：中文和英文。採用RevMan 5.0軟件對符閤納入標準的文獻採用固定效應模型或隨機效應模型進行 Meta 分析。結果共納入文獻14篇，其中有關燐痠二酯酶抑製劑預防高原性肺動脈高壓的文獻9篇，有關波生坦的文獻4篇，有關地塞米鬆的文獻2篇，有關乙酰唑胺和銀杏葉提取物的文獻1篇。試驗組共包括185例研究對象，安慰劑組共包括168例研究對象。14篇文獻報道瞭藥物對肺動脈壓的影響，閤併效應量 MD =-6.22，95% CI（-8.24，-4.20），亞組分析顯示燐痠二酯酶抑製劑、地塞米鬆與安慰劑間差異有統計學意義〔 MD =-6.55，95% CI（-8.72，-4.37），P <0.00001；MD =-17.37，95% CI（-24.61，-10.13），P <0.00001〕，波生坦與安慰劑比較，差異無統計學意義〔 MD =-2.39，95% CI（-7.20，2.42），P =0.33〕。共5篇文獻報道瞭對心輸齣量的影響，試驗組和安慰劑組間差異無統計學意義〔MD =0.55，95% CI（0.10，1.01），P =0.67〕，對其進行亞組分析，燐痠二酯酶抑製劑可增加心輸齣量，組間差異有統計學意義〔MD =0.65，95% CI（0.14，1.16），P =0.01〕。共8篇文獻報道瞭對血壓的影響，試驗組和安慰劑組間差異無統計學意義〔MD =-2.68，95% CI（-6.28，0.92），P =0.57〕。共11篇文獻報道瞭對心率的影響，試驗組和安慰劑組間差異無統計學意義〔MD =-0.67，95% CI（-6.20，4.86），P =0.81〕，進一步行亞組分析，地塞米鬆可增加心輸齣量，組間差異有統計學意義〔MD =-16.60，95% CI（-29.22，-3.99），P =0.01）〕。共10篇文獻報道瞭對血氧飽和度的影響，試驗組和安慰劑組間差異無統計學意義〔 MD =0.83，95% CI（-0.78，2.44），P =0.31〕。結論燐痠二酯酶抑製劑、地塞米鬆可有效預防低海拔人群暴露高原環境下肺動脈壓的升高，而波生坦無效。
목적：계통평개고원성폐동맥고압적약물예방작용。방법전자검색 Cochrane 도서관、PubMed、Else-vise、중국지망、만방수거고、유보수거고，검색시간2004년11월-2013년11월；검색어충：중문화영문。채용RevMan 5.0연건대부합납입표준적문헌채용고정효응모형혹수궤효응모형진행 Meta 분석。결과공납입문헌14편，기중유관린산이지매억제제예방고원성폐동맥고압적문헌9편，유관파생탄적문헌4편，유관지새미송적문헌2편，유관을선서알화은행협제취물적문헌1편。시험조공포괄185례연구대상，안위제조공포괄168례연구대상。14편문헌보도료약물대폐동맥압적영향，합병효응량 MD =-6.22，95% CI（-8.24，-4.20），아조분석현시린산이지매억제제、지새미송여안위제간차이유통계학의의〔 MD =-6.55，95% CI（-8.72，-4.37），P <0.00001；MD =-17.37，95% CI（-24.61，-10.13），P <0.00001〕，파생탄여안위제비교，차이무통계학의의〔 MD =-2.39，95% CI（-7.20，2.42），P =0.33〕。공5편문헌보도료대심수출량적영향，시험조화안위제조간차이무통계학의의〔MD =0.55，95% CI（0.10，1.01），P =0.67〕，대기진행아조분석，린산이지매억제제가증가심수출량，조간차이유통계학의의〔MD =0.65，95% CI（0.14，1.16），P =0.01〕。공8편문헌보도료대혈압적영향，시험조화안위제조간차이무통계학의의〔MD =-2.68，95% CI（-6.28，0.92），P =0.57〕。공11편문헌보도료대심솔적영향，시험조화안위제조간차이무통계학의의〔MD =-0.67，95% CI（-6.20，4.86），P =0.81〕，진일보행아조분석，지새미송가증가심수출량，조간차이유통계학의의〔MD =-16.60，95% CI（-29.22，-3.99），P =0.01）〕。공10편문헌보도료대혈양포화도적영향，시험조화안위제조간차이무통계학의의〔 MD =0.83，95% CI（-0.78，2.44），P =0.31〕。결론린산이지매억제제、지새미송가유효예방저해발인군폭로고원배경하폐동맥압적승고，이파생탄무효。
Objective This study performed a system evaluation to explore the prevention of drugs for high altitude pulmonary hypertension. Methods Cochrane library,PubMed,Elsevise,CNKI,Wanfang and Vip databases were searched for some relevant articles between November 2004 and 2013 which were published in Chinese and English. RevMan 5. 0 software was used for fixed or random effects model Meta - analysis of articles meeting the inclusion criteria. Results Finally,this study included 14 articles(9 articles about phosphodiesterase inhibitor,4 articles about bosentan,2 articles about dexamethasone and 1 article about acetazolamide with ginkgo biloba extract). Subjects in all were involved including 185 in experimental group and 168 in placebo group. 14 articles reported the effectiveness of drugs on pulmonary artery pressure〔 MD = - 6. 22,95% CI ( - 8. 24, - 4. 20)〕. The subgroup analysis showed that placebo had significant difference with both phosphodiesterase inhibitor and dexamethasone〔MD = - 6. 55,95% CI( - 8. 72, - 4. 37),P < 0. 000 01;MD = - 17. 37,95% CI( - 24. 61,- 10. 13),P < 0. 000 01〕but no difference with the drug of bosentan〔MD = - 2. 39,95% CI( - 7. 20,2. 42),P = 0. 33〕. 5 articles reported the effectiveness of drugs on cardiac output. There was no significant difference between experimental group and placebo group〔MD = 0. 55,95% CI(0. 10,1. 01),P = 0. 67〕. The subgroup analysis showed that phosphodiesterase in-hibitors could increase cardiac output,each subgroup had significant difference with each other〔MD = 0. 65,95% CI(0. 14, 1. 16),P = 0. 01〕. 8 articles reported the effectiveness of drugs on blood pressure. There was no significant difference between experimental group and placebo group〔MD = - 2. 68,95% CI( - 6. 28,0. 92),P = 0. 57〕. 11 articles reported the effec-tiveness of drugs on heart rate. Two groups had no significant difference〔 MD = - 0. 67,95% CI( - 6. 20,4. 86),P =0. 81〕. The subgroup analysis showed that dexamethasone could increase cardiac output and each subgroup had significant differ-ence with each other〔MD = - 16. 60,95% CI( - 29. 22, - 3. 99),P = 0. 01〕. 10 articles reported the effectiveness of drugs on oxygen saturation. Two groups had no significant difference〔MD = 0. 83,95% CI( - 0. 78,2. 44),P = 0. 31〕. Conclusion Phosphodiesterase inhibitors and dexamethasone can effectively prevent pulmonary artery pressure to rise who came from lower altitude and exposed in plateau in a short time. However,bosentan was ineffective.