经胸超声心动图引导与造影引导经皮封堵治疗动脉导管未闭的系统评价与Meta分析

目的比较经胸超声心动图与造影引导经皮封堵治疗动脉导管未闭(PDA)的疗效,为临床应用提供指导。方法计算机检索中国知网、万方、维普、PubMed及Cochrane Library,查找国内外有关经胸超声心动图与造影引导治疗PDA的对照研究,检索时限均从建库至2019年4月,由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.3软件对所收集的资料进行Meta分析。结果最终纳入8篇中文文献,总样本量为681例。Meta分析结果显示,超声组与造影组的手术成功率差异无统计学意义(RR=0.99,95%CI 0.97~1.01,P=0.40);超声组的术后并发症少于造影组(RR=0.26,95%CI 0.11~0.59,P=0.001)。超声组手术时间(P<0.00001)、术中射线量(P<0.00001)、射线暴露时间(P<0.00001)、住院时间(P<0.00001)、住院费用(P<0.00001)均少或短于造影组,差异有统计学意义。结论与造影引导比较,经胸超声心动图引导经皮封堵治疗PDA是一种创伤小、费用低、安全有效的方法,可代替造影引导作为PDA经皮封堵的引导方式之一。

Percutaneous closure of patent ductus arteriosus guided by transthoracic echocardiography or angiography: A systematic review and meta-analysis

Objective To compare the efficacy of percutaneous closure guided by transthoracic echocardiography or angiography in the treatment of patent ductus arteriosus(PDA).Methods Literature databases such as CNKI,VIP,Wanfang Database,PubMed,Cochrane Library were searched for collecting published literatures on percutaneous closure for PDA guided by transthoracic echocardiography and angiography,retrieval time limit was up to April 2019.Two evaluators independently screened the literature,extracted the data and evaluated the quality according to inclusion and exclusion criteria.The collected data were analyzed by RevMan 5.3 software.Results Eight studies were included finally,with a total sample size of 681 cases.Meta-analysis showed that there was no statistical difference in the operative success rate between the echocardiography group and the angiography group(RR=0.99,95%CI 0.97-1.01,P=0.40).Postoperative complications were less in the echocardiography group than those in the angiography group(RR=0.26,95%CI 0.11-0.59,P=0.001).The operation time(P<0.00001),amount of intraoperative radiation(P<0.00001),exposure time(P<0.00001),hospitalization days(P<0.00001)and hospitalization costs(P<0.00001)in the echocardiography group were less or shorter than those in the angiography group,and the difference was statistically different.Conclusion Compared with angiography-guided,transthoracic echocardiography-guided percutaneous closure for PDA is a safe and effective method with less trauma,lower cost,and can replace angiography as one of the guiding methods for PDA.