中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
12期
1316-1320
,共5页
张步春%刘伟静%侯磊%李海玲%李伟明%徐亚伟
張步春%劉偉靜%侯磊%李海玲%李偉明%徐亞偉
장보춘%류위정%후뢰%리해령%리위명%서아위
心脏再同步%起搏器%除颤器%植入型%心力衰竭%病死率%猝死率%荟萃分析
心髒再同步%起搏器%除顫器%植入型%心力衰竭%病死率%猝死率%薈萃分析
심장재동보%기박기%제전기%식입형%심력쇠갈%병사솔%졸사솔%회췌분석
Cardiac resynchronization%Pacemaker%Defibrillators%Implantable%Heart failure%Mortality%Sudden death%Meta-analysis
目的 比较心脏再同步治疗起搏器(cardiac resynchronization therapy,CRT)与心脏再同步治疗除颤器(cardiac resynchronization therapy -defibrillator,CRT-D)对心力衰竭患者预后的影响.方法 通过计算机和手工检索MEDLINE、Cochrane临床试验中心登记库、EMBASE和中国万方、中国知网(CNKI)数据库,收集1990年1月1日至2011年9月30日CRT与CRT-D对心力衰竭患者生存疗效影响的随机对照研究、前瞻观察性研究和病例对照研究.按纳入标准与排除标准选择文献,提取资料,采用RevMan 5.0软件对患者全因病死率、心脏猝死率和心衰病死率数据进行荟萃分析.结果 共纳入7项研究3404例患者,结果提示CRT-D组全因病死率低于CRT组(OR =0.61,95％ CI:0.47～0.79,P=0.01),亚组分析显示随访时间≤1年差异无统计学意义(OR =0.76,95％ CI:0.54 ～ 1.06,P=0.11),随访时间＞1年差异有统计学意义(OR=0.56,95％ CI:0.41～0.77,P=0.0004).CRT-D组心源性猝死(OR=0.20,95％ CI:0.07～0.59,P=0.003)和心衰病死(OR =0.72,95％ CI:0.54～0.96,P=0.02)也分别低于CRT组.结论 CRT-D对心力衰竭患者的预后可能优于CRT.
目的 比較心髒再同步治療起搏器(cardiac resynchronization therapy,CRT)與心髒再同步治療除顫器(cardiac resynchronization therapy -defibrillator,CRT-D)對心力衰竭患者預後的影響.方法 通過計算機和手工檢索MEDLINE、Cochrane臨床試驗中心登記庫、EMBASE和中國萬方、中國知網(CNKI)數據庫,收集1990年1月1日至2011年9月30日CRT與CRT-D對心力衰竭患者生存療效影響的隨機對照研究、前瞻觀察性研究和病例對照研究.按納入標準與排除標準選擇文獻,提取資料,採用RevMan 5.0軟件對患者全因病死率、心髒猝死率和心衰病死率數據進行薈萃分析.結果 共納入7項研究3404例患者,結果提示CRT-D組全因病死率低于CRT組(OR =0.61,95％ CI:0.47～0.79,P=0.01),亞組分析顯示隨訪時間≤1年差異無統計學意義(OR =0.76,95％ CI:0.54 ～ 1.06,P=0.11),隨訪時間＞1年差異有統計學意義(OR=0.56,95％ CI:0.41～0.77,P=0.0004).CRT-D組心源性猝死(OR=0.20,95％ CI:0.07～0.59,P=0.003)和心衰病死(OR =0.72,95％ CI:0.54～0.96,P=0.02)也分彆低于CRT組.結論 CRT-D對心力衰竭患者的預後可能優于CRT.
목적 비교심장재동보치료기박기(cardiac resynchronization therapy,CRT)여심장재동보치료제전기(cardiac resynchronization therapy -defibrillator,CRT-D)대심력쇠갈환자예후적영향.방법 통과계산궤화수공검색MEDLINE、Cochrane림상시험중심등기고、EMBASE화중국만방、중국지망(CNKI)수거고,수집1990년1월1일지2011년9월30일CRT여CRT-D대심력쇠갈환자생존료효영향적수궤대조연구、전첨관찰성연구화병례대조연구.안납입표준여배제표준선택문헌,제취자료,채용RevMan 5.0연건대환자전인병사솔、심장졸사솔화심쇠병사솔수거진행회췌분석.결과 공납입7항연구3404례환자,결과제시CRT-D조전인병사솔저우CRT조(OR =0.61,95％ CI:0.47～0.79,P=0.01),아조분석현시수방시간≤1년차이무통계학의의(OR =0.76,95％ CI:0.54 ～ 1.06,P=0.11),수방시간＞1년차이유통계학의의(OR=0.56,95％ CI:0.41～0.77,P=0.0004).CRT-D조심원성졸사(OR=0.20,95％ CI:0.07～0.59,P=0.003)화심쇠병사(OR =0.72,95％ CI:0.54～0.96,P=0.02)야분별저우CRT조.결론 CRT-D대심력쇠갈환자적예후가능우우CRT.
Objective To evaluate the effects of cardiac resynchronization therapy with pacemaker (CRT- P) and cardiac resynchronization therapy with defibrillator (CRT -D) on the outcomes of patients with heart failure.Methods MEDLINE,Cochrane Controlled Trials Register,EMBASE and Chinese Wan Fang,CNKI database were searched to collect data from randomized controlled trials and cohort trials of CRT - P versus CRT - D for the treatment of heart failure from January 1,1990 through September 30,2011.Meta - analysis of data including all causes leading to mortality and mortality of sudden cardiac arrest and heart failure was carried out by using the RevMan 5.0 package.Results A total of 3 404 patients were collected from seven studies.Pooled analysis demonstrated CRT - D significantly reduced mortalities of all causes in comparison with CRT - P [ odds ratio (OR) =0.61,95％ confidence interval (CI) =0.47 ～0.79,P =0.0001 ].Sub - group analysis showed that an increased benefit was seen after extended follow -up period ( after 1 year,OR =0.56,95 ％ CI =0.41 ～ 0.77,P =0.0004),but not after relatively short follow - up period ( within one year,OR =0.76,95 ％ CI =0.54 ～ 1.06,P =0.11 ).Mortalities of sudden cardiac arrest ( OR =0.20,95％ CI =0.07 ～ 0.59,P =0.003) and heart failure ( OR =0.72,95％ CI =0.54 ～ 0.96,P =0.02) of patients treated with CRT - D were lower than those of patients treated with CRT- P.Conclusions This study suggests that CRT - D is superior over CRT - P in respect of better outcome of patients with heart failure.
