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目的:系统评价急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)时冠状动脉(冠脉)内辅助应用腺苷对心肌再灌注损伤及心肌梗死范围的改善作用。方法:电脑检索国内外数据库,纳入研究冠脉内辅助应用腺苷治疗急性STEMI患者的前瞻性随机对照试验。两名检索员独立进行检索、文献质量评价和数据提取,并对纳入研究的质量进行评价,使用Review Manager 5.3进行分析和图表制作。结果:最终纳入14篇文献,共4 331例病例。将其分为2个亚组:冠脉内注射腺苷组(9篇)和静脉使用腺苷组(5篇)。经冠脉注射腺苷的患者心力衰竭发生率明显降低(RR=0.44,95%CI:0.25~0.78,P=0.005),且冠脉无复流的发生率降低(RR=0.65,95%CI:0.46~0.93,P=0.02)。静脉使用腺苷组中的心力衰竭发生率没有差异。经冠脉注射腺苷与静脉使用腺苷在非致命性心肌梗死和全因死亡率方面无显著差异。结论:经冠脉介入治疗中辅助使用腺苷可较好改善STEMI患者临床预后。
OBJECTIVE: To evaluate the effects of adenosine supplementation with intracoronary (coronary) coronary artery on myocardial reperfusion injury and infarct size in patients with acute ST-elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI) . METHODS: We searched the databases at home and abroad and included prospective randomized controlled trials of intracoronary adenosine adjuvant adenosine in patients with acute STEMI. Two searchers conducted independent searches, literature quality reviews and data extraction, evaluated the quality of the included studies and used Review Manager 5.3 for analysis and charting. Results: Finally, 14 articles were included for a total of 4,331 cases. Divided into two subgroups: intracoronary adenosine group (n = 9) and intravenous adenosine group (n = 5). The incidence of heart failure was significantly lower in patients receiving adenosine for coronary artery disease (RR = 0.44, 95% CI: 0.25-0.78, P = 0.005), and the incidence of coronary artery no-reflow decreased (RR = 0.65, 95% CI : 0.46 ~ 0.93, P = 0.02). The incidence of heart failure in intravenous adenosine did not differ. There was no significant difference in non-fatal myocardial infarction and all-cause mortality when adenosine was administered via coronary artery versus intravenous adenosine. Conclusions: The adjuvant use of adenosine during PCI can improve the prognosis of patients with STEMI.