极化液对急性心肌梗死患者心功能影响的系统评价

目的系统评价极化液对急性心肌梗死（AMI）患者心功能的影响。方法计算机检索PubMed、EMbase、Cochrane图书馆（2007年第4期）、中国生物医学文献光盘数据库等，纳入极化液治疗AMI的临床随机对照试验（RCT），评价极化液治疗后患者心功能（左室射血分数、ST段变化、左室重塑）的变化。由两名评价员独立选择试验和提取资料，并按照Cochrane系统评价员手册的4条质量评价标准评价纳入文献的方法学质量，而后应用RevMan4．2．10软件进行Meta分析。结果共纳入5个RCT，研究地点均在国外，研究质量均较高，各试验间具有基线可比性。Meta分析结果显示：极化液治疗组较生理盐水对照组对左室射血分数的改善无差异WMD=1.87，95％CI（-0.32，4.06），P=0.09]，但极化液明显有助于ST段的下降OR=1.92，95％CI（1.25，2.96），P=0.003]和阻遏心肌重构的发生OR=0.08，95％CI（0.01，0.68），P=0.02]。结论现有的证据表明，尽管极化液在一定程度上有利于AMI患者ST段的下降及远期预后，但尚不能得出极化液能改善AMI患者心功能的结论。今后有必要实施重点关注极化液使用时间的更为严格的大型RCT，以充分论证极化液对AMI的治疗作用。

Effect of Glucose-Insulin-Potassium on Heart Function of Patients with Acute Myocardial Infarction: A Systematic Review

Objective To evaluate the efficacy of glucose-insulin-potassium （GIK） in patients with acute myocardial infarction （AMI）. Methods Both foreign language databases including The Cochrane Library （issue 4,2007）, PubMed, EMBASE and Chinese databases involving CBM, VIP and CIFD were searched to identify randomized controlled trials （RCTs） that reported the effect of GIK on the heart function （left ventricular ejection fraction LVEF, ST changes, left ventricular remodeling） of patients with AMI. Two reviewers assessed the quality of each trial and extracted data independently. The Cochrane Collaboration＇s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological quality of the included studies was good. The baseline data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group （WMD=l.87, 95%CI -0.32 to 4.06, P=0.09）, whereas GIK was more beneficial in decreasing ST （OR=1.92, 95%CI 1.25 to 2.96, P=0.003） and preventing left ventricular remodeling （OR=0.08, 95%CI 0.01 to 0.68, P=0.02）. Conclusions Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.