目的系统评价胺碘酮预防心脏外科术后心房颤动（房颤）有效性和安全性。方法计算机检索中国生物医学文献数据库（1978~2014.07）、中国期刊全文数据库（1994~2014.07）、维普数据库（1999~2014.07）、万方数据库（1990~2014.07）、Pub Med（1990~2014.07）、Cochrane Library（2014第07期）。按纳入排除标准由两名研究者独立进行筛选,并提取资料,采用改良的JADAD量表评价纳入研究的质量后,采用Rev Man 5.2软件进行Meta分析。结果共纳入18篇文献,均为随机对照研究,总共1964例患者。Meta分析结果显示：与安慰剂（对照组）相比,胺碘酮（试验组）降低心脏外科术后房颤发生率（RR=1.46,95%CI：1.36~1.57,P〈0.00001）,而安全性无统计学差异（RR=1.16,95%CI：0.89~1.50,P=0.27）。亚组分析显示,胺碘酮不同给药方式和不同首次给药时间均对心脏外科术后房颤有效性无明显影响,与总有效性一致。结论与安慰剂相比,胺碘酮可以有效地降低心脏外科术后房颤的发生率,安全性无明显差异。
目的:评价重组人脑利钠肽(rhBNP)对中国人群急性心衰患者的疗效和安全性,为临床实践和研究提供参考和依据。方法:计算机检索PubMed,Web of Knowledge,VIP,CNKI和万方数据库。手工检索所有纳入文献的相关参考文献,筛选有关rhBNP治疗中国人群急性心衰患者的随机对照试验,在符合纳入与排除标准的文献中提取数据,采用RevMan5.2版软件进行Meta分析。结果:纳入20篇文献,包括1 739名患者,其中rhBNP组(实验组)865例,常规治疗组(对照组)874例。Meta分析结果显示:提高左室射血分数rhBNP组优于对照组(WMD=7.82,95%CI:7.04-8.60)、降低左室舒张末期容积rhBNP组优于对照组(WMD=-1.54,95%CI:-2.41--0.66)、降低NT-proBNP水平比较rhBNP组优于常规治疗组(WMD=-839.75,95%CI:-1 264.87--414.62)、心功能改善有效率rhBNP组优于对照组(OR=4.42,95%CI:3.25-6.02)、不良反应发生率rhBNP组与对照组相比差异无统计学意义(OR=0.63,95%CI:0.38-1.06)。发表偏倚及敏感性分析提示纳入的研究无明显发表偏倚,稳定性较好。结论:与常规治疗相比,rhBNP对于中国人群急性心衰患者的心功能等级与预后均有明显的改善作用,且无明显不良反应。
An optimal therapy for pulmonary embolism(PE) was explored by comparing three different methods in order to alleviate the sufferings of PE patients and reduce the mortality. Eighty patients with PE diagnosed by computed tomography angiography(CTA) were treated with thrombolysis, anticoagulation only, or surgery/intervention. The clinical efficacy of different treatments were compared and analyzed. Twenty-four out of the 26 patients(92%) in anticoagulation only group showed improvement in CTA and clinical presentations, which was significantly higher than that in the thrombolysis group(87%, n=39, P<0.05). However, there was no significant difference in the rate of mortality between thrombolysis group and anticoagulation only group. In the surgery/interventional group(n=15), the success rate was 47%, and the mortality rate was 14%. Both of them were significantly different from those in thrombolysis and anticoagulation only groups(both P<0.05). Log-rank analysis of the data of 5-year follow-up revealed that the survival time in surgery/intervention group was significantly shorter than in the other two groups(P<0.05). It was suggested that it is of importance to choose the appropriate therapeutic regimen for PE patients. Mortality may be reduced and prognosis may be improved with anticoagulation only and thrombolysis therapy.
