中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2015年
8期
466-471
,共6页
李志霞%王梦汝%李舜%高盼君%孙凤%詹思延
李誌霞%王夢汝%李舜%高盼君%孫鳳%詹思延
리지하%왕몽여%리순%고반군%손봉%첨사연
胸主动脉覆膜支架%腹主动脉覆膜支架%全死因死亡%发生率%Meta分析
胸主動脈覆膜支架%腹主動脈覆膜支架%全死因死亡%髮生率%Meta分析
흉주동맥복막지가%복주동맥복막지가%전사인사망%발생솔%Meta분석
Thoracic stent graft%Abdominal stent graft%All-cause mortality%Incidence Meta-analysis
目的 系统评价胸、腹主动脉覆膜支架用于人体后所导致的心肌梗死、截瘫、肾衰竭、呼吸衰竭、脑卒中、全死因死亡6种主要不良反应事件的发生情况.方法 以“Thoracic aortic aneurysm/aneurysm of thoracic aorta/chest aortic aneurysm"、“Abdominal aortic aneurysm/abdominal aneurysm”、"Thoracic aortic coated stents/ thoracic stent graft”、“Abdominal aorta coated stents/abdominal stent graft”、“Endovascular aortic repair"和“Safety”等为关键词在PubMed、Embase、OVID、ProQuest、Elsevier和The Cochrane Library 6个数据库(均从最早至2014年5月)中制定检索策略,系统检索胸、腹主动脉覆膜支架导致上述6种主要不良反应事件的随访研究,包括随机对照试验研究、病例系列研究和队列研究.采用Meta-Analyst软件选择随机效应Meta分析模型对6种不良反应事件发生率进行加权合并;针对全死因死亡事件按照年龄、男性比例和随访时间进行亚组分析,并根据质量评价结果进行敏感性分析.结果 根据入选及排除标准,共纳入152篇文献,按随访时间拆分后形成264个研究.结果显示,胸主动脉覆膜支架总的不良反应事件发生率为12.2％,其中全死因死亡发生率最高(8.1％),呼吸衰竭的发生率次之(6.5％).腹主动脉覆膜支架总的不良反应发生率为4.6％,其中全死因死亡的发生率最高(4.0％),心肌梗死的发生率次之(2.1％).胸、腹主动脉覆膜支架亚组分析结果均提示,中年人群、男性比例较低的研究全死因死亡率较高;随访时间越长,全死因死亡率越高.结论 胸、腹主动脉覆膜支架用于人体后所导致的6种不良反应事件发生率均较高,尤其全死因死亡率最高,应对患者进行密切监测与随访.
目的 繫統評價胸、腹主動脈覆膜支架用于人體後所導緻的心肌梗死、截癱、腎衰竭、呼吸衰竭、腦卒中、全死因死亡6種主要不良反應事件的髮生情況.方法 以“Thoracic aortic aneurysm/aneurysm of thoracic aorta/chest aortic aneurysm"、“Abdominal aortic aneurysm/abdominal aneurysm”、"Thoracic aortic coated stents/ thoracic stent graft”、“Abdominal aorta coated stents/abdominal stent graft”、“Endovascular aortic repair"和“Safety”等為關鍵詞在PubMed、Embase、OVID、ProQuest、Elsevier和The Cochrane Library 6箇數據庫(均從最早至2014年5月)中製定檢索策略,繫統檢索胸、腹主動脈覆膜支架導緻上述6種主要不良反應事件的隨訪研究,包括隨機對照試驗研究、病例繫列研究和隊列研究.採用Meta-Analyst軟件選擇隨機效應Meta分析模型對6種不良反應事件髮生率進行加權閤併;針對全死因死亡事件按照年齡、男性比例和隨訪時間進行亞組分析,併根據質量評價結果進行敏感性分析.結果 根據入選及排除標準,共納入152篇文獻,按隨訪時間拆分後形成264箇研究.結果顯示,胸主動脈覆膜支架總的不良反應事件髮生率為12.2％,其中全死因死亡髮生率最高(8.1％),呼吸衰竭的髮生率次之(6.5％).腹主動脈覆膜支架總的不良反應髮生率為4.6％,其中全死因死亡的髮生率最高(4.0％),心肌梗死的髮生率次之(2.1％).胸、腹主動脈覆膜支架亞組分析結果均提示,中年人群、男性比例較低的研究全死因死亡率較高;隨訪時間越長,全死因死亡率越高.結論 胸、腹主動脈覆膜支架用于人體後所導緻的6種不良反應事件髮生率均較高,尤其全死因死亡率最高,應對患者進行密切鑑測與隨訪.
목적 계통평개흉、복주동맥복막지가용우인체후소도치적심기경사、절탄、신쇠갈、호흡쇠갈、뇌졸중、전사인사망6충주요불량반응사건적발생정황.방법 이“Thoracic aortic aneurysm/aneurysm of thoracic aorta/chest aortic aneurysm"、“Abdominal aortic aneurysm/abdominal aneurysm”、"Thoracic aortic coated stents/ thoracic stent graft”、“Abdominal aorta coated stents/abdominal stent graft”、“Endovascular aortic repair"화“Safety”등위관건사재PubMed、Embase、OVID、ProQuest、Elsevier화The Cochrane Library 6개수거고(균종최조지2014년5월)중제정검색책략,계통검색흉、복주동맥복막지가도치상술6충주요불량반응사건적수방연구,포괄수궤대조시험연구、병례계렬연구화대렬연구.채용Meta-Analyst연건선택수궤효응Meta분석모형대6충불량반응사건발생솔진행가권합병;침대전사인사망사건안조년령、남성비례화수방시간진행아조분석,병근거질량평개결과진행민감성분석.결과 근거입선급배제표준,공납입152편문헌,안수방시간탁분후형성264개연구.결과현시,흉주동맥복막지가총적불량반응사건발생솔위12.2％,기중전사인사망발생솔최고(8.1％),호흡쇠갈적발생솔차지(6.5％).복주동맥복막지가총적불량반응발생솔위4.6％,기중전사인사망적발생솔최고(4.0％),심기경사적발생솔차지(2.1％).흉、복주동맥복막지가아조분석결과균제시,중년인군、남성비례교저적연구전사인사망솔교고;수방시간월장,전사인사망솔월고.결론 흉、복주동맥복막지가용우인체후소도치적6충불량반응사건발생솔균교고,우기전사인사망솔최고,응대환자진행밀절감측여수방.
Objective The purpose of this study was to review all published reports on thoracic/ abdominal stent graft and investigate the incidence rates of six main adverse events(MAEs):myocardial infarction,paraplegia,renal failure,respiratory failure,stroke and all-cause mortality.Methods Electronic databases(PubMed、Embase、OVID、ProQuest、Elsevier and The Cochrane Library) were searched from inception through May 2014 to identify studies that assessed the safety of thoracic/abdominal aortic coated stents on MAEs.The incidence rates with 95％ confidence intervals(95％ CIs) were derived using a random effects model,considering the heterogeneity between the included studies.Subgroup and sensitivity analyses were applied to explore heterogeneity.Results A total of 152 studies were included in the analysis with 264 arms.For thoracic stent graft,meta-analysis yielded a combined estimated incidence rates of 12.2％,and the most common MAEs was all-cause mortality (8.1％),followed by respiratory failure (6.5 ％).For abdominal stent graft,meta-analysis yielded a combined estimated incidence rates of 4.6％,and the most common MAEs was all-cause mortality(4.0％),followed by myocardial infarction(2.1％).For thoracic and abdominal stent graft,subgroup analysis stratified by age and proportion of males indicated that middle-aged and females have a higher incidence rates of all-cause mortality.Besides,subgroup analysis stratified by follow-up time indicated that the longer follow-up time,the higher incidence rate of all-cause mortality.Conclusion The current evidence indicates that the incidence of MAEs of thoracic and abdominal stent graft is high,and we should pay more attention to the patients and follow up them as long as possible.
