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目的:通过meta分析评价缺血后处理对改善心肌缺血再灌注损伤的影响,为临床提供证据。方法:纳入有关选择急性ST段抬高型心肌梗死(STEMI)患者在经皮冠状动脉介入治疗中施行后处理的前瞻性随机对照试验。提取肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、左心室射血分数(LVEF)等观察数据,使用Review Manager 5.1软件进行meta分析。结果:17项随机对照研究符合纳入标准。对纳入文献进行研究分析后,发现在给予急性STEMI患者施行PCI中附加后处理可以明显降低术后CK释放峰值:WMD:469.23 U,95%CI(-622.50,-315.96)(P<0.05);CK-MB释放峰值:WMD 64.71U,95%CI(-91.34,-38.07)(P<0.05);提高LVEF 7d后WMD:4.47%,95%CI(1.27,7.67)(P=0.006)和3个月后WMD:5.85%,95%CI(2.58,9.12)(P=0.0005)。结论:在给STEMI患者施行PCI治疗同时施行缺血后处理,能减少患者的CK和CK-MB释放峰值,提高近期及中长期LVEF。有理由相信临床中对急性STEMI患者在行PCI中施行后处理可以使此类患者获益,但该结果需要更多大型随机对照试验来进一步论证。
OBJECTIVE: To evaluate the effect of ischemic postconditioning on improving myocardial ischemia-reperfusion injury by meta-analysis and provide evidence for clinical practice. METHODS: A prospective randomized controlled trial of post-treatment for percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI) was enrolled. Observations of creatine kinase (CK), creatine kinase (CK-MB) and left ventricular ejection fraction (LVEF) were extracted and analyzed using Review Manager 5.1 software. Results: Seventeen RCTs met the inclusion criteria. After investigating the included literature, we found that additional postconditioning in patients with acute STEMI can significantly reduce postoperative peak CK release: WMD: 469.23 U, 95% CI (-622.50, -315.96) (P <0.05); WMD: 4.47%, 95% CI (1.27, 7.67) (P = 0.006), and 3 (P = 0.006) after 7 days of LVEF After a month WMD: 5.85%, 95% CI (2.58, 9.12) (P = 0.0005). CONCLUSIONS: PCI in patients with STEMI while ischemic postconditioning can reduce peak CK and CK-MB release and increase LVEF in the immediate and long-term. There is reason to believe that clinical benefit of post-PCI in patients with acute STEMI can benefit such patients, but the results require more large randomized controlled trials to further demonstrate.