CAJ | 학술논문

目的汇集有关ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)所致院外心脏骤停(out-of-hospital cardiac arrest,OHCA)的文献,分别对冠脉介入(percutaneous coronary intervention,PCI)与静脉溶栓在自主循环恢复(return of spontaneous circulation,ROSC)后患者中的疗效进行比较；通过揭示两种疗法对此阶段患者存活出院及神经功能恢复方面的作用,明确ROSC阶段治疗的重要性,以期指导对由STEMI所致OHCA患者的救治.方法本研究通过查询PUBMED和MEDLINE数据库,对1995年1月至2011年10月间的有关STEMI所致OHCA的研究文献进行了回顾性分析,以获得ROSC的OHCA患者为研究对象,相关患者的存活出院率和神经功能良好率作为此项研究的评判标准.共有18篇文献纳入此项研究,由于Meta分析必须是同期对照性研究,笔者将同一队列研究中获得ROSC后接受PCI的患者作为治疗组、拒绝PCI的患者作为对照组；与之相应,接受静脉溶栓的患者作为治疗组、拒绝静脉溶栓的患者作为对照组；然后,利用Review Manager 5.1软件对各自相应的治疗组与对照组间进行Meta分析.此外,也对PCI与静脉溶栓两种疗法对此类患者的出院率及神经功能良好率间的差异,采用Pearson x2进行比较.结果在由STEMI所致OHCA的患者中,Meta分析显示了对ROSC后患者的存活出院率方面PCI[OR(odds ratio,优势比),1.65; 95％CI(confidence interval,可信区间),1.05-2.59,P＜0.01]与静脉溶栓(OR,2.03; 95％CI,1.24 ～3.34,P＜0.01)明显优于各自的对照组；总体比较中,静脉溶栓与PCI在此类患者的存活出院率(63.00％vs.65.19％,P=0.548)及神经功能恢复率(88.62％ vs.91.25％,P=0.351)方面具有相似的结果.结论对STEMI所致的OHCA患者,在ROSC后进行PCI或静脉溶栓能够提高存活出院率；静脉溶栓在救治此类患者中具有与PCI同等的效益.
목적 회집유관ST단태고형심기경사(ST-elevation myocardial infarction,STEMI)소치원외심장취정(out-of-hospital cardiac arrest,OHCA)적문헌,분별대관맥개입(percutaneous coronary intervention,PCI)여정맥용전재자주순배회복(return of spontaneous circulation,ROSC)후환자중적료효진행비교；통과게시량충요법대차계단환자존활출원급신경공능회복방면적작용,명학ROSC계단치료적중요성,이기지도대유STEMI소치OHCA환자적구치.방법 본연구통과사순PUBMED화MEDLINE수거고,대1995년1월지2011년10월간적유관STEMI소치OHCA적연구문헌진행료회고성분석,이획득ROSC적OHCA환자위연구대상,상관환자적존활출원솔화신경공능량호솔작위차항연구적평판표준.공유18편문헌납입차항연구,유우Meta분석필수시동기대조성연구,필자장동일대렬연구중획득ROSC후접수PCI적환자작위치료조、거절PCI적환자작위대조조；여지상응,접수정맥용전적환자작위치료조、거절정맥용전적환자작위대조조；연후,이용Review Manager 5.1연건대각자상응적치료조여대조조간진행Meta분석.차외,야대PCI여정맥용전량충요법대차류환자적출원솔급신경공능량호솔간적차이,채용Pearson x2진행비교.결과 재유STEMI소치OHCA적환자중,Meta분석현시료대ROSC후환자적존활출원솔방면PCI[OR(odds ratio,우세비),1.65; 95％CI(confidence interval,가신구간),1.05-2.59,P＜0.01]여정맥용전(OR,2.03; 95％CI,1.24 ～3.34,P＜0.01)명현우우각자적대조조；총체비교중,정맥용전여PCI재차류환자적존활출원솔(63.00％vs.65.19％,P=0.548)급신경공능회복솔(88.62％ vs.91.25％,P=0.351)방면구유상사적결과.결론 대STEMI소치적OHCA환자,재ROSC후진행PCI혹정맥용전능구제고존활출원솔；정맥용전재구치차류환자중구유여PCI동등적효익.
Objective To evaluate the effect of percutaneous coronary intervention (PCI) or thrombolysis,in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA),in the presence of ST-elevation myocardial infarction (STEMI).We demonstrated the benefits of the two therapies on ROSC patients in hospital discharge and neurological recovery,and clarified the importance of ROSC,so as to guide the treatments for OHCA in the presence of STEMI.Methods It was performed a meta-analysis of clinical studies located in PUBMED and MEDLINE databases from January 1995 to October 2011.OHCA patients with ROSC were as our study objects,the hospital discharge and neurological recovery rates,of patients with and without PCI or thrombolysis,were assessed in patients with ROSC after OHCA in the presence of STEMI.In the same Cohort Study,between received and rejected PCI,or between received and rejected thrombolysis in OHCA patients with ROSC as treated group and control group,using Review Manager 5.1 software to analyze,respectively.Furthermore,we also compared the differences in hospital discharge and neurological recovery rates between patient groups who received PCI or thrombolysis by Pearson x2 analysis.Results The meta-analysis showed that the rate of hospital discharge improved with both PCI (odds ratio [OR],1.65 ; 95％ confidence interval [CI],1.05-2.59,P ＜ 0.01)and thrombolysis (OR,2.03 ; 95％ CI,1.24-3.34,P ＜ 0.01) in patients with ROSC after OHCA,in the presence of STEMI.We also found that there were not significant differences between with PCI and with thrombolysis in the rate of hospital discharge (63.00％ vs.65.19％,P =0.548) and neurological recovery (88.62％ vs.91.25％,P =0.351) for the patients with ROSC after OHCA (P ＞0.05).Conclusions In patients with ROSC after OHCA in the presence of STEMI,both PCI and thrombolysis improved hospital discharge rates.Furthermore,there were similar efficacy in hospital discharge and neurological recovery rates between with PCI and with thrombolysis.