極化液對急性心肌梗死患者心功能影響的系統評價_《中國循證醫學雜志》

作者：

楊朝輝 ¹² ,  楊克虎 ² , 馬彬 ² , 尹少甫 ¹

1.蘭州大學基礎醫學院（蘭州 730000）2.蘭州大學循證醫學中心（蘭州 730000）;

關鍵詞：

極化液心肌梗死心功能隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20080025

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目的　系統評價極化液對急性心肌梗死（AMI）患者心功能的影響。
方法　計算機檢索 PubMed、EMbase、Cochrane 圖書館（2007 年第 4 期）、中國生物醫學文獻光盤數據庫等，納入極化液治療 AMI 的臨床隨機對照試驗（RCT），評價極化液治療后患者心功能（左室射血分數、ST 段變化、左室重塑）的變化。由兩名評價員獨立選擇試驗和提取資料，并按照Cochrane 系統評價員手冊的 4 條質量評價標準評價納入文獻的方法學質量，而后應用 RevMan 4.2.10 軟件進行 Meta 分析。
結果　共納入 5 個 RCT，研究地點均在國外，研究質量均較高，各試驗間具有基線可比性。Meta分析結果顯示：極化液治療組較生理鹽水對照組對左室射血分數的改善無差異 [WMD=1.87，95%CI（-0.32， 4.06），P=0.09]，但極化液明顯有助于 ST段的下降[OR=1.92， 95%CI（1.25， 2.96），P=0.003]和阻遏心肌重構的發生 [OR=0.08，95%CI（0.01，0.68），P=0.02]。
結論　現有的證據表明，盡管極化液在一定程度上有利于 AMI 患者 ST 段的下降及遠期預后，但尚不能得出極化液能改善 AMI 患者心功能的結論。今后有必要實施重點關注極化液使用時間的更為嚴格的大型RCT，以充分論證極化液對AMI的治療作用。

引用本文： 楊朝輝,楊克虎,馬彬,尹少甫. 極化液對急性心肌梗死患者心功能影響的系統評價. 中國循證醫學雜志, 2008, 08(2): 97-101. doi: 10.7507/1672-2531.20080025 復制

1.	高潤霖. 急性心肌梗死診斷和治療指南.中華心血管病雜志, 2001, 29(12): 711.
2.	Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛寧, 譯. 中國循證醫學雜志, 2004, 4(6): 426.
3.	Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4.	Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5.	Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6.	Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7.	Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8.	Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9.	Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10.	Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11.	Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12.	Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13.	Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14.	Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15.	Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16.	Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17.	Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18.	Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19.	Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

1. 高潤霖. 急性心肌梗死診斷和治療指南.中華心血管病雜志, 2001, 29(12): 711.
2. Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛寧, 譯. 中國循證醫學雜志, 2004, 4(6): 426.
3. Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4. Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5. Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6. Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7. Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8. Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9. Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10. Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11. Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12. Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13. Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15. Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16. Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17. Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19. Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

《中國循證醫學雜志》

極化液對急性心肌梗死患者心功能影響的系統評價

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《中國循證醫學雜志》

極化液對急性心肌梗死患者心功能影響的系統評價

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