尼可地爾預防冠脈內支架置入術后無再流效果的系統評價_《中國循證醫學雜志》

作者：

張小衛 ^1,2 , 馬彬 ² , 楊克虎 ^2,3 , 張宇龍 ² ,  白鋒 ¹

1. 蘭州大學第二醫院（蘭州 730000）；2. 蘭州大學循證中心，蘭州大學基礎醫學院（蘭州 730000）；3. 蘭州大學第一醫院（蘭州 730000）;

關鍵詞：

無再流冠狀動脈介入治療尼可地爾隨機對照試驗系統評價

DOI：

10.7507/1672-2531.20100450

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目的　系統評價尼可地爾預防冠脈內支架置入術后慢血流/ 無再流的臨床療效與安全性。
方法　電子檢索Cochrane 對照試驗注冊數據庫（2009 年第2 期）、PubMed、MEDLINE、EMbase、CBM、CNKI、VIP、萬方數據資源（截至2009 年4 月）。由2 名評價者獨立評價納入研究的質量、提取資料并交叉核對，對同質研究采用RevMan5.0 軟件進行Meta 分析。
結果　共納入7 個研究，包括630 例患者。Meta 分析結果顯示：冠脈和靜脈內注射尼可地爾可明顯減少無再流/ 慢血流的發生，冠脈和靜脈內注射尼可地爾可以改善TIMI 計幀數（CTFC），靜脈內注射尼可地爾可以增加左室射血分數；在不良反應方面，雖然尼可地爾組未減少心肌再梗死、死亡和靶血管重建的發生率，但可明顯減少室顫/ 室速、心包積液及心衰的發生率，且尼可地爾可以明顯減少總的心臟不良事件發生率。
結論　本系統評價結果顯示，冠脈和靜脈內注射尼可地爾均可以起到降低冠脈內支架置入術后無再流/ 慢血流的發生率和TIM 計幀數的效果，且在提高左室射血分數和減少術后不良反應方面，均可獲得較好的效果。但限于納入研究在方法學方面的局限性，尚需開展大樣本、高質量的RCT 進一步論證其療效和安全性。

引用本文： 張小衛,馬彬,楊克虎,張宇龍,白鋒. 尼可地爾預防冠脈內支架置入術后無再流效果的系統評價. 中國循證醫學雜志, 2010, 10(5): 564-569. doi: 10.7507/1672-2531.20100450 復制

1.	Zijlstra F, de Boer MJ, Hoorntje JC, et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med, 1993, 328(10): 680-684.
2.	Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA, 1997, 278(23): 2093-2098.
3.	Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet, 2003, 361 (9351): 13-20.
4.	Abbo KM, Dooris M, Glazier S, et al. Features and outcome of noreflow after percutaneous coronary intervention. Am J Cardiol, 1995,.
5.	Resnic FS, Wainstein M, Lee MK, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J, 2003, 145(1): 42-46.
6.	Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of ’no-reflow’ after percutaneous coronary intervention. Circulation, 1994, 89(6): 2514-2518.
7.	Lee HC, An SG, Choi JH, et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J, 2008, 72 (9): 1425-1429.
8.	Fujiwara T, Matsunaga T, Kameda K, et al. Nicorandil suppresses the increases in plasma level of matrix metalloproteinase activity and attenuates left ventricular remodeling in patients with acute myocardial infarction. Heart Vessels, 2007, 22(5): 303-309.
9.	Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
10.	Ota S, Nishikawa H, Takeuchi M, et al. Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J, 2006, 70(9): 1099-1104.
11.	Ono H, Osanai T, Ishizaka H, et al. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: role of inhibitory effect on reactive oxygen species formation. Am Heart J, 2004, 148(4): E15.
12.	Kawai Y, Hi samat su K, Mat subara H, et al . Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J, 2009, 30(7): 765-772.
13.	Ishii H, Ichimiya S, Kanashiro M, et al. Effects of intravenous nicorandil before reperfusion for acute myocardial infarction in patients with stress hyperglycemia. Diabetes Care, 2006, 29(2): 202-206.
14.	吳文利, 梅霞, 羅羽慧. 尼可地爾治療冠心病穩定型心絞痛68例. 中國藥業, 2005, 14(5): 65-66.
15.	李海亮. 尼可地爾治療冠心病穩定型心絞痛72例臨床分析. 中國社區醫師, 2008, 10(9): 32.
16.	(12): 778-782.

1. Zijlstra F, de Boer MJ, Hoorntje JC, et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med, 1993, 328(10): 680-684.
2. Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA, 1997, 278(23): 2093-2098.
3. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet, 2003, 361 (9351): 13-20.
4. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of noreflow after percutaneous coronary intervention. Am J Cardiol, 1995,.
5. Resnic FS, Wainstein M, Lee MK, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J, 2003, 145(1): 42-46.
6. Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of ’no-reflow’ after percutaneous coronary intervention. Circulation, 1994, 89(6): 2514-2518.
7. Lee HC, An SG, Choi JH, et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J, 2008, 72 (9): 1425-1429.
8. Fujiwara T, Matsunaga T, Kameda K, et al. Nicorandil suppresses the increases in plasma level of matrix metalloproteinase activity and attenuates left ventricular remodeling in patients with acute myocardial infarction. Heart Vessels, 2007, 22(5): 303-309.
9. Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
10. Ota S, Nishikawa H, Takeuchi M, et al. Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J, 2006, 70(9): 1099-1104.
11. Ono H, Osanai T, Ishizaka H, et al. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: role of inhibitory effect on reactive oxygen species formation. Am Heart J, 2004, 148(4): E15.
12. Kawai Y, Hi samat su K, Mat subara H, et al . Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J, 2009, 30(7): 765-772.
13. Ishii H, Ichimiya S, Kanashiro M, et al. Effects of intravenous nicorandil before reperfusion for acute myocardial infarction in patients with stress hyperglycemia. Diabetes Care, 2006, 29(2): 202-206.
14. 吳文利, 梅霞, 羅羽慧. 尼可地爾治療冠心病穩定型心絞痛68例. 中國藥業, 2005, 14(5): 65-66.
15. 李海亮. 尼可地爾治療冠心病穩定型心絞痛72例臨床分析. 中國社區醫師, 2008, 10(9): 32.
16. (12): 778-782.

《中國循證醫學雜志》

尼可地爾預防冠脈內支架置入術后無再流效果的系統評價

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《中國循證醫學雜志》

尼可地爾預防冠脈內支架置入術后無再流效果的系統評價

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