CAJ | 학술논문

目的评价经左右桡动脉行冠状动脉造影术的效果.方法计算机检索PubMed、Embase、Web of Science 、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库、万方数据库和中国知网,时间从建库至2013年1月.由2名研究人员独立按照纳入和排除标准以及Cochrane协作网推荐的方法筛选文献、评价质量,并采用Revman 5.1软件进行荟萃分析.结果共纳入11项研究,包括5 442例患者.荟萃分析显示:与经右桡动脉途径比较,经左桡动脉途径行冠状动脉造影术没有增加手术失败率(OR=1.04,95％ CI0.80 ～ 1.35,P＞0.05)；在对比剂用量方面两者差异无统计学意义(均数差=2.39,95％ CI-0.30 ～5.08,P＞0.05)；经左桡动脉途径透视时间短于经右桡动脉途径(标准化均数差=0.15,95％ CI0.06 ～0.24,P＜0.01)；经右桡动脉途径出现严重锁骨下动脉迂曲的可能性是经左桡动脉途径的4.65倍(OR =4.65,95％ CI 1.98 ～ 10.88,P＜0.01).结论与经右桡动脉途径比较,经左桡动脉途径行冠状动脉造影术同样安全,且有一定的优势.左桡动脉既可以作为冠状动脉造影术的备选途径,也可以作为常规初始途径.
목적 평개경좌우뇨동맥행관상동맥조영술적효과.방법 계산궤검색PubMed、Embase、Web of Science 、Cochrane Library、중국생물의학문헌수거고、중문과기기간전문수거고、만방수거고화중국지망,시간종건고지2013년1월.유2명연구인원독립안조납입화배제표준이급Cochrane협작망추천적방법사선문헌、평개질량,병채용Revman 5.1연건진행회췌분석.결과 공납입11항연구,포괄5 442례환자.회췌분석현시:여경우뇨동맥도경비교,경좌뇨동맥도경행관상동맥조영술몰유증가수술실패솔(OR=1.04,95％ CI0.80 ～ 1.35,P＞0.05)；재대비제용량방면량자차이무통계학의의(균수차=2.39,95％ CI-0.30 ～5.08,P＞0.05)；경좌뇨동맥도경투시시간단우경우뇨동맥도경(표준화균수차=0.15,95％ CI0.06 ～0.24,P＜0.01)；경우뇨동맥도경출현엄중쇄골하동맥우곡적가능성시경좌뇨동맥도경적4.65배(OR =4.65,95％ CI 1.98 ～ 10.88,P＜0.01).결론 여경우뇨동맥도경비교,경좌뇨동맥도경행관상동맥조영술동양안전,차유일정적우세.좌뇨동맥기가이작위관상동맥조영술적비선도경,야가이작위상규초시도경.
Objective To compare the efficacy between left radial approach (LRA) and right radial approach (RRA) for coronary angiography (CAG).Methods The following databases were searched,including PubMed,Embase,Web of science,Cochrane Library,CBM,VIP,Wanfang databases and CNKI,from creation of database to January 2013.Two reviewers extracted data independently,according to inclusive criteria,exclusion criteria and methods of Cochrane Collaboration.Statistical analysis was performed using Review Manager Software (RevMan 5.1).Results Eleven trials with 5 442 patients were included in the systematic review.The results of meta-analysis showed that when compared with RRA,LRA did not increase the failure rate of the procedures (OR =1.04,95％ CI 0.80-1.35,P ＞ 0.05) and amount of contrast medium(mean difference =2.39,95％ CI-0.30-5.08),P ＞ 0.05).However,LRA was superior to RRA in reducing fluoroscopy time (standardized mean difference =0.15,95％ CI0.06-0.24,P ＜ 0.01).In addition,the incidence of severe tortuosity of subclavian artery was significantly lower with LRA (OR=4.65,95％CI 1.98-10.88,P＜0.01).Conclusions Based on the current evidence,LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects.LRA can thus be used either as an alternative approach or routine approach for CAG.