急性心肌梗塞患者心肺复苏后溶栓治疗的Meta分析

目的根据现有临床研究评价急性心肌梗塞患者心肺复苏后溶栓治疗的有效性和安全性。方法从1966年至2004年8月MEDLINE数据库检索以急性心肌梗塞并行心肺复苏的患者为研究对象,收集比较溶栓与非溶栓治疗效果的临床研究文献,并对文献结果进行Meta分析。结果共9篇临床研究文献入选。心肌梗塞患者心肺复苏后溶栓治疗可以显著提高患者的出院生存率(P<0.01)并改善远期神经功能(P<0.01),合并比数比分别是2.61(95%可信区间为1.91～3.57)和2.59(95%可信区间为1.70～3.95)。相比非溶栓治疗,溶栓治疗显著增加了严重性出血的发生率(P<0.01),比数比为2.20(95%可信区间为1.25～3.88)。结论与非溶栓治疗比较,心肺复苏后溶栓治疗的严重性出血率较高。但从整体而言,对心肺复苏成功的心肌梗塞患者进行溶栓治疗可以显著提高患者的出院生存率并改善远期神经功能。

Comparison of Thrombolysis and Non-thrombolysis during Cardiopulmonary Resuscitation in Acute Myocardial Infarction: a Meta-analysis

Object To overview studies on thrombolysis in patients with acute myocardial infarction (AMI) who need cardiopulmonary resuscitation (CPR) and evaluate the safety and efficacy of thrombolysis. Method Clinical studies on comparison thrombolysis and non-thrombolysis administered to patients during CPR were selected from MEDLINE from 1966 to August of 2004. A meta-analysis was employed to evaluate the results of the two therapies. Results 9 studies are included in the meta-analysis. Compared with non-thrombolysis, thrombolysis shows significant higher rate of discharge alive and better cerebral performance, but significant higher major bleeding rate (P < 0.01). Conclusion Thrombolytic therapy increases the risk of major bleeding, but it can prominently improve the rate of discharge alive and cerebral performance on the whole.