CAJ | 학술논문

目的：系统评价经桡动脉与经股动脉途径行经皮冠状动脉介入术（PCI）治疗ST段抬高性心肌梗死（STEMI）疗效及安全性，为临床实践提供最佳证据。方法计算机全面检索PubMed（1994~2014.05）、EMbase（2000~2014.05）、Cochrane Library（2012年第4期）、CBM （2004~2014.05）、CNKI（2004~2014.05）、Wanfang data（2004~2014.05），查找经股动脉途径介入治疗STEMI的疗效及安全性的随机对照试验（RCT）。由2名评价员按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.2软件进行Meta分析。结果最终共纳入13个RCT共5158例。Meta分析结果显示：与经股动脉途径组相比，经桡动脉途径组可以明显减少死亡率（2.8% vs.4.8%；OR：0.56，95%CI：0.41~0.77；P＜0.001），主要大出血发生率（1.3%vs.2.9%；OR：0.48，95%CI：0.31~0.72；P＜0.001)，主要不良心脏事件（MACE）发生率（4.6%vs.6.8%；OR：0.64，95%CI：0.50~0.83；P＜0.001），穿刺部位并发症（2.0%vs.5.6%；OR：0.34，95%CI：0.24~0.48；P＜0.00001）；缩短住院天数（SMD：0.64；95%CI：0.50~0.83；P＜0.05）。在手术成功率，X线曝光时间，造影剂剂量，再梗死率，脑卒中发生率，冠状动脉旁路移植术（CABG）发生率，与经股动脉组相比并无统计学差异。但经桡动脉途径介入治疗比经股动脉途径的术中穿刺时间，手术时间长，更改穿刺途径发生率较多，均存在统计学差异。结论与经股动脉行PCI术相比，经桡动脉途径治疗STEMI具有明显优势。它可明显减少STEMI患者死亡率、主要大出血发生率、MACE和穿刺部位并发症，故在严格把握适应证，提高术者的手术技能情况下，经桡动脉介入治疗STEMI是安全有效的，但其远期疗效和更全面的安全性尚需开展更多大样本、高质量的RCT加以验证。
목적：계통평개경뇨동맥여경고동맥도경행경피관상동맥개입술（PCI）치료ST단태고성심기경사（STEMI）료효급안전성，위림상실천제공최가증거。방법계산궤전면검색PubMed（1994~2014.05）、EMbase（2000~2014.05）、Cochrane Library（2012년제4기）、CBM （2004~2014.05）、CNKI（2004~2014.05）、Wanfang data（2004~2014.05），사조경고동맥도경개입치료STEMI적료효급안전성적수궤대조시험（RCT）。유2명평개원안조납입화배제표준독립진행문헌사선、자료제취화질량평개후，채용RevMan 5.2연건진행Meta분석。결과최종공납입13개RCT공5158례。Meta분석결과현시：여경고동맥도경조상비，경뇨동맥도경조가이명현감소사망솔（2.8% vs.4.8%；OR：0.56，95%CI：0.41~0.77；P＜0.001），주요대출혈발생솔（1.3%vs.2.9%；OR：0.48，95%CI：0.31~0.72；P＜0.001)，주요불양심장사건（MACE）발생솔（4.6%vs.6.8%；OR：0.64，95%CI：0.50~0.83；P＜0.001），천자부위병발증（2.0%vs.5.6%；OR：0.34，95%CI：0.24~0.48；P＜0.00001）；축단주원천수（SMD：0.64；95%CI：0.50~0.83；P＜0.05）。재수술성공솔，X선폭광시간，조영제제량，재경사솔，뇌졸중발생솔，관상동맥방로이식술（CABG）발생솔，여경고동맥조상비병무통계학차이。단경뇨동맥도경개입치료비경고동맥도경적술중천자시간，수술시간장，경개천자도경발생솔교다，균존재통계학차이。결론여경고동맥행PCI술상비，경뇨동맥도경치료STEMI구유명현우세。타가명현감소STEMI환자사망솔、주요대출혈발생솔、MACE화천자부위병발증，고재엄격파악괄응증，제고술자적수술기능정황하，경뇨동맥개입치료STEMI시안전유효적，단기원기료효화경전면적안전성상수개전경다대양본、고질량적RCT가이험증。
Objective To review systematically the curative effects and safety of perradial or transfemoral percutaneous coronary interventions (PCI) on ST-segment elevation myocardial infarction (STEMI).Methods The databases of PubMed (from 1994 to May 2014), EMbase (from 2000 to May 2014), Cochrane Library (No. 4 of 2012 Vol.), CBM (from 2004 to May 2014), CNKI (from 2004 to May 2014) and WanFang Database (from 2004 to May 2014) were retrieved with computer for searching the randomized controlled trials (RCT) about the curative effect and safety of transfemoral PCI on STEMI. All materials were given document screen, data extract and quality review by 2 reviewers according to inclusion and exclusion criteria, and then given a Meta-analysis by using RevMan5.2 software.Results There were finally 13 RCT included involving 5158 cases. The results of Meta-analysis showed that mortality (2.8%vs. 4.8%;OR: 0.56, 95%CI: 0.41~0.77;P<0.001), major bleeding incidence (1.3%vs.2.9%;OR: 0.48, 95%CI: 0.31~0.72;P<0.001), MACE incidence (4.6%vs. 6.8%;OR: 0.64, 95%CI: 0.50~0.83;P<0.001), puncture site complications (2.0%vs. 5.6%;OR: 0.34, 95%CI: 0.24~0.48;P<0.00001) and hospitalization days (SMD: 0.64; 95%CI: 0.50-0.83;P<0.05) decreased significantly in perradial PCI group compared with transfemoral PCI group. The difference in procedure success rate, X-ray exposure time, contrast agent dosage, re-infarction rate, stroke incidence and CABG rate had no statistical significance between 2 groups. The puncture time and procedure time were longer and incidence of changing puncture pathways was higher in perradial PCI group than those in transfemoral PCI group.Conclusion The perradial PCI is superior to transfemoral PCI in treatment of STEMI, and it can reduce mortality, major bleeding incidence, MACE and puncture site complications. Under the condition of fitting strictly indications and improving operators’ skills, perradial PCI is safe and effective, but the long-term <br> curative effect and overall safety are needed to be confirmed with more large-sample and high-quality RCT.