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单纯超声心动图引导下经皮封堵与经胸封堵治疗房间隔缺损疗效比较的Meta分析

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摘要:

目的 系统评价单纯超声心动图引导下经皮封堵与经胸封堵治疗房间隔缺损的安全性和
有效性。方法 计算机检索PubMed、The Cochrane Library、EMbase、VIP、Wanfang Data和CNKI数据
库,搜索关于单纯超声心动图引导下经皮封堵和经胸封堵治疗房间隔缺损相关研究文献,检索时限均
从2000年1月~2018年8月。由两名研究员按纳入与排除标准独立筛选文献、提取资料并评价质量,应
用RevMan 5.3软件进行Meta分析。结果 共纳入6个研究304例患者,Meta分析结果显示:经皮封堵组治
疗房间隔缺损在总并发症发生率(RR=0.41, 95%CI:0.24~0.72,P=0.002)、手术时间(SMD=-2.35,
95%CI:-2.90~-1.80,P<0.00001)、住院时间(SMD=-2.25,95%CI:-3.12~-1.39,P<0.0001)比较
上均优于经胸封堵,但在手术成功率、残余分流发生率和手术花费方面,差异无统计学意义。结论 超
声心动图引导下经皮封堵较经胸封堵治疗房间隔缺损手术时间短、患者术后并发症少且康复较快。经胸
封堵可在经皮封堵困难或不满足其适应证时作为代替治疗方案。

Abstract:

Objective To review systematically the safety and effectiveness of percutaneous occlusion and
transthoracic occlusion in treatment of atrial septal defect (ASD) guided by simple echocardiography. Methods
The databases including PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI were retrieved
for searching the study literature related to ASD treatment with percutaneous occlusion and transthoracic occlusion
guided by simple echocardiography from Jan. 2000 to Aug. 2018. The literature was screened independently by 2
researchers according to inclusion and exclusion criteria, the data was extracted and quality was reviewed, and a
Meta-analysis was conducted by using RevMan 5.3 software. Results There were totally 6 studies and 304 patients
included. The results of Meta-analysis showed that the total incidence rate of complications (RR=0.41, 95%CI:
0.24~0.72, P=0.002), operation duration (SMD=-2.35, 95%CI: -2.90~-1.80, P<0.00001) and length of hospital
stay (SMD=-2.25, 95%CI: -3.12~-1.39, P<0.0001) were all superior in percutaneous occlusion group to those
in transthoracic occlusion group. The difference in success rate, incidence rate of residual shunts and operation
cost had no statistical significance between 2 groups. Conclusion The operative time is shorter, postoperative
complications are fewer and rehabilitation is faster in ASD treatment with transthoracic occlusion guided by simple
echocardiography than those in ASD treatment with transthoracic occlusion. Transthoracic occlusion can be used as
an alternative therapy when percutaneous closure is difficult or its indications are not satisfied.

基金项目:

甘肃省卫生行业科研计划项目(GSWSKY2016-04)

参考文献:

  • 2008

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