冠脉内注射肾上腺素防治PCI术后无复流的系统评价和meta分析

李秋艳; 何石荣; 苏强

doi:10.16766/j.cnki.issn.1674-4152.003224

冠脉内注射肾上腺素防治PCI术后无复流的系统评价和meta分析

doi: 10.16766/j.cnki.issn.1674-4152.003224

桂林医学院附属医院心血管内科，广西桂林 541000

基金项目:

2020年广西科技计划项目重点研发计划桂科AB20159005

详细信息

通讯作者:
苏强，E-mail：suqiang1983@glmc.edu.cn

中图分类号: R541.4 R972
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- 文章访问数: 164
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- 被引次数: 0
出版历程
- 收稿日期: 2023-01-17
- 网络出版日期: 2023-11-23

Systematic evaluation and meta-analysis of intracoronary injection of epinephrine for preventing no-reflow after PCI

Department of Cardiology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000, China

摘要

摘要: 目的系统评价肾上腺素防治经皮冠状动脉介入治疗(PCI)术后无复流的有效性与安全性，为临床治疗进一步提供依据。方法通过检索Cochrane对照试验资料库、PubMed、EMbase、中国生物医学文献数据库、万方数据库以及中国知网这6个数据库自建库以来至2022年7月关于PCI术后无复流、慢血流的相关文献，严格遵循纳入和排除标准，筛选、提取、核对，最后使用RevMan 5.3软件进行meta分析。结果共选中5个研究，合计527例患者。最终分析结果显示：冠脉内注射肾上腺素可明显改善心肌梗死溶栓治疗临床试验(TIMI)血流，减少无复流/慢血流现象的发生率(RR=0.52，95% CI: 0.37~0.72，P＜0.001)；同时，就不良反应而言，肾上腺素可明显降低PCI术中低血压的发生率，且2组差异有统计学意义(P < 0.05)；但PCI术后TIMI计帧数(CTFC)、心肌显影密度分级(MBG)、住院期间及PCI术后30 d主要不良心脏事件的发生率以及PCI术后左室射血分数(LVEF)的影响，2组差异均无统计学意义(均P＞0.05)；基于不同对照组对于PCI术后TIMI血流、CTFC进行的亚组分析，结果显示肾上腺素与不同对照组差异的结果与亚组分析之前的结果相似，差异无统计学意义。结论本系统评价结果显示，冠脉内注射肾上腺素可以起到降低PCI术后无复流/慢血流发生率的效果，并且术中低血压发生率低于维拉帕米、硝普钠等药物。但受限于研究的局限性，还需纳入更多样本量的随机对照研究进一步证实。
- 肾上腺素 /
- 经皮冠状动脉介入治疗 /
- 无复流 /
- 系统评价
Abstract: Objective To systematically evaluate the effectiveness and safety of epinephrine in the prevention and treatment of no-reflow after percutaneous coronary intervention (PCI), and to provide a further basis for clinical management. Methods The Cochrane Controlled Trials Database, PubMed, EMbase, China Biology Medicine disc, Wanfang Database and China National Knowledge Infrastructure were searched for relevant literature on no-reflow and slow flow after PCI since the establishment of the database to July 2022, and the inclusion and exclusion criteria were strictly followed to screen, extract, check and final meta-analysis was performed using RevMan 5.3 software. Results A total of 5 studies were selected, with a combined total of 527 patients. The final analysis showed that intracoronary epinephrine injection significantly improved thrombolysis in myocardial infarction trial (TIMI) flow and reduced the incidence of no/slow flow phenomenon (RR=0.52, 95% CI: 0.37-0.72, P < 0.001). Meanwhile, in terms of adverse effects, epinephrine significantly reduced the incidence of intraoperative hypotension during PCI, and the difference between the two groups was statistically significant (P < 0.05). However, for the effects of post-PCI corrected TIMI frame count (CTFC), myocardial blush grade (MBG), incidence of major adverse cardiovascular events (MACEs) during hospitalization and 30 days post-PCI, and post-PCI left ventricular ejection fraction (LVEF), the differences between the two groups were not statistically significant (all P>0.05). A subgroup analysis based on different control groups for TIMI blood flow, CTFC after PCI showed that the results of the difference between epinephrine and different control groups were similar to those before the subgroup analysis and were not statistically significant. Conclusion The results of this systematic evaluation show that intracoronary injection of epinephrine may have the effect of reducing the incidence of no-reflow/slow flow after PCI and that the incidence of intraoperative hypotension is lower than that of drugs such as verapamil and nitroprusside. However, due to the limitations of the study, further confirmation is needed by including randomized controlled trials with larger sample sizes
- Epinephrine /
- Percutaneous coronary intervention /
- No reflow /
- Systematic evaluation

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图 1 肾上腺素与对照组对PCI术后无复流/慢血流发生率的影响

Figure 1. Effect of adrenaline on the occurrence of no-reflow/slow-flow after PCI compared to the control group

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图 2 肾上腺素与对照组对PCI术后CTFC的影响

Figure 2. Effect of adrenaline on the CTFC after PCI compared to the control group

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图 3 肾上腺素与对照组对PCI术后主要不良心脏事件的影响

Figure 3. Effect of adrenaline on the major adverse cardiac events after PCI compared to the control group

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图 4 肾上腺素与对照组对PCI术后左室射血分数的影响

Figure 4. Effect of adrenaline on the left ventricular ejection fraction after PCI compared to the control group

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图 5 肾上腺素vs.不同对照组对PCI术后无复流/慢血流发生率的亚组分析

Figure 5. Subgroup analysis of the impact of adrenaline versus different control groups on the occurrence of no-reflow/slow-flow after PCI

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图 6 肾上腺素vs.不同对照组对PCI术后CTFC的亚组分析

Figure 6. Subgroup analysis of the impact of adrenaline versus different control groups on CTFC after PCI

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表 1 纳入研究的基本情况

Table 1. Basic information on the studies included

纳入研究	年份	年龄(x±s，岁)		样本量		给药方式	干预措施		测量指标
纳入研究	年份	研究组	对照组	研究组	对照组	给药方式	研究组	对照组	测量指标
曹乾等^[11]	2016	68.2±13.5	67.7±9.2	42	38	冠脉内	50~150 μg肾上腺素	200~600 μg维拉帕米	①②③④
田芳等^[15]	2017	69.32±12.11	68.27±12.89	37	31	冠脉内	50~150 μg肾上腺素	200~600 μg维拉帕米	①②③
陈皓等^[14]	2018	58.89±11.13	56.42±9.28	41	39	冠脉内	50~200 μg肾上腺素	200~800 μg硝普钠	①②③④⑤
王晓英等^[13]	2020	60.7±8.3	59.5±9.0	49	49	冠脉内	50~150 μg肾上腺素	等量生理盐水	①②
KHAN K A等^[12]	2022	56.82±11.91	57.49±10.88	101	100	冠脉内	100~600 μg肾上腺素	60~1 000 μg腺苷	①②③④⑥
注：①为TIMI血流分级; ②为CTFC; ③为LVEF; ④为MACEs; ⑤为低血压发生率；⑥为MBG。

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