CAJ | 학술논문

目的系统评价中国人心脏瓣膜置换术后低强度抗凝治疗的疗效和安全性.方法检索1990年1月至2010月12月中国生物医学数据库(CBM)、中国知网(CNKI)、维普中文科技期刊数据库、PubMed及Cochrane图书馆有关心脏瓣膜置换术后抗凝治疗的中文文献,按纳入及排除标准进行筛选及质量评估,对照研究文献进行荟萃分析,叙述性研究行描述性分析.结果纳入文献61篇,其中对照研究4篇,叙述性研究57篇.荟萃分析及描述性分析结果均提示,低强度抗凝组的抗凝总并发症发生率及出血率均较传统强度组明显降低(RR=-0.06,95％CI:-0.08～-0.03,P＜0.001;RR=-0.06,95％ CI:-0.08～0.04,P＜0.001),而两组间栓塞率差异并无统计学意义(RR =0.01,95％ CI:-0.01～0.03,P＞0.05).结论心脏瓣膜置换术后低强度抗凝治疗取得了在栓塞并发症发生率无明显增高的基础上,出血并发症发生及死亡率显著降低的成果,该治疗安全、有效,是适合中国人凝血特点的治疗方法.
목적 계통평개중국인심장판막치환술후저강도항응치료적료효화안전성.방법 검색1990년1월지2010월12월중국생물의학수거고(CBM)、중국지망(CNKI)、유보중문과기기간수거고、PubMed급Cochrane도서관유관심장판막치환술후항응치료적중문문헌,안납입급배제표준진행사선급질량평고,대조연구문헌진행회췌분석,서술성연구행묘술성분석.결과 납입문헌61편,기중대조연구4편,서술성연구57편.회췌분석급묘술성분석결과균제시,저강도항응조적항응총병발증발생솔급출혈솔균교전통강도조명현강저(RR=-0.06,95％CI:-0.08～-0.03,P＜0.001;RR=-0.06,95％ CI:-0.08～0.04,P＜0.001),이량조간전새솔차이병무통계학의의(RR =0.01,95％ CI:-0.01～0.03,P＞0.05).결론 심장판막치환술후저강도항응치료취득료재전새병발증발생솔무명현증고적기출상,출혈병발증발생급사망솔현저강저적성과,해치료안전、유효,시괄합중국인응혈특점적치료방법.
Objective To investigate the safety and efficacy of low intensity anticognlation therapy for chinese population underwent heart valve replacemnt.Methods From January 1999 to October 2010,the literatures concering anticoagulation therapy for chinese population with heart valve replacement were researched in following databases:CBM,CNKI,VIP,Pubmed as well as cochrane library.Screening and quality evaluation was conducted according to the inclusion and exclusion criteria.Meta-analysis of control studies and descriptive analysis of descriptive studies were conducted.Results Total 61 articles were reviewed,including 4 control studies and 57 descriptive studies.Both Meta analysis and descriptive analysis results showed also that the rates of total anticoagulation-related complications as well as bleeding events were significantly decreased in patients receiving low intensity anticoagulation therapy in compared with classical intensity strategy (RR =-0.06,95 ％ CI:-0.08--0.03,P ＜ 0.001 ; RR =-0.06,95 ％ CI:-0.08-0.04,P ＜0.001),while no significant differeces were noted as for risk of thrmoboembolic events among two different intensity groups(RR =0.01,95％ CI:-0.01-0.03,P ＞0.05).Conclusions Low intensity anticoagulation therapy(INR ≤2.5) could effectively miminze the anticoagulation-related hemorrhage and mortality rates and while without increasing the rates of thrmoboembolic event.This therapy was safe,effective and suitable for the coagulation characteristics of Chinese population.