溶栓联合抗凝治疗次大面积肺栓塞的Meta分析

Thrombolysis combined with anticoagulation therapy in the treatment of submassive pulmonary embolism：a Meta analysis

摘要:

目的：系统评价溶栓联合抗凝治疗次大面积肺栓塞（submassive pulmonary embolism，SPE）的疗效和安全性。方法：计算机检索PubMed、EMbase、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库和万方数据库，并辅手工检索其他资料，纳入溶栓联合抗凝治疗SPE的随机对照试验（randomized controlled trials，RCTs），检索日期截至2013年6月。由2名研究者按照纳入与排除标准独立筛选文献、提取资料并对纳入研究进行质量评价。用RevMan 5.0软件对数据进行Meta分析。结果：共纳入9个RCTs，共计861例患者。Meta分析结果显示：①溶栓联合抗凝疗法可提高SPE患者的总体有效率（OR＝5.97，95％CI＝3.51～10.15，P=0.000），与对照组比较，差异有统计学意义（P＜0.05）；②溶栓联合抗凝疗法可有效改善患者动脉血氧分压、动脉血二氧化碳分压及肺泡-动脉血氧分压差，而且对呼吸频率及心率的改善也有一定积极作用，与对照组比较，差异有统计学意义（P＜0.05）。结论：现有资料表明，与单纯抗凝治疗相比，溶栓联合抗凝疗法可提高SPE患者的总体有效率，改善患者的动脉血气情况及临床相关症状。此外，溶栓联合抗凝疗法的安全性由于纳入研究质量参差不齐，故仍需后期研究进一步探讨。

Abstract:

Objective：To evaluate the effects and safety of thrombolysis combined with anticoagulation therapy in the treatment of sub－massive pulmonary embolism（SPE）. Methods：Published literatures concerning randomized controlled trials（RCTs） of thrombolysis combined with anticoagulation therapy for patients with SPE were retrieved from PubMed，EMbase，Cochrane Library，CNKI，CBM and WanFang database by computer and handsearch was used to collect other studies before the deadline of June 2013. According to the inclusive and exclusive criteria，literature and data were independently screened and extracted by two researchers，meanwhile，the quality of the included studies was assessed. Meta analysis was conducted by RevMan 5.0 software. Results：A total of nine RCTs including 861 patients with SPE were enrolled. Meta analysis demonstrated that：①thrombolysis combined with anticoagulation therapy could improve the overall efficiency of patients with SPE（OR＝5.97，95％CI=3.51 to 10.15），P=0.000）.②thrombolysis combined with anticoagulation therapy could effectively improve PaO2，PaCO2，P（A-a）O2，respiratory rate and heart rate（P＜0.05）. Conclusion：Avail－able data indicate that the overall efficiency，arterial blood gas and clinical symptoms of patients with SPE can be improved by throm－bolysis combined with anticoagulation therapy than by anticoagulation alone. Moreover，safety needs further study due to the quality of included studies.