伊布利特與胺碘酮轉復房顫, 房撲效果的Meta分析_《中國循證醫學雜志》

作者：

董曉 ¹ , 朱賽楠 ² ,  丁文惠 ¹

1. 北京大學第一醫院心血管內科（北京 100034）；2. 北京大學第一醫院統計科（北京 100034）;

關鍵詞：

伊布利特胺碘酮心房顫動心房撲動心臟復律 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120032

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目的　系統評價目前國內外伊布利特和胺碘酮治療心房顫動、心房撲動的療效及安全性。
方法　計算機檢索PubMed、EMbase、CNKI、WanFang Data、VIP數據庫和Cochrane圖書館（2011年第2期），查找1994年1月～2011年1月期間發表的所有關于伊布利特和胺碘酮轉復房顫、房撲的中、英文隨機對照試驗（RCT）。由兩位研究者按照納入排除標準進行文獻篩選、資料提取和方法學質量評價后，采用RevMan 5.0軟件進行Meta 分析。
結果　最終納入8個RCT，共計506例患者。Meta分析結果顯示：① 伊布利特組轉復房顫、房撲的總有效率優于胺碘酮組［OR=2.27，95%CI（1.19，4.33），P=0.01］；② 4個研究的合并分析結果顯示，伊布利特組轉復房顫的療效與胺碘酮組相當［OR=1.61，95%CI（0.96，2.71），P=0.07］，但伊布利特組轉復房撲的療效更優［OR=8.97，95%CI（4.51，17.84），P lt;0.000 01］；③ 5個研究的合并分析結果顯示，伊布利特組轉復房顫、房撲時間明顯短于胺碘酮組［WMD= –126.55 min，95%CI（–202.35，–50.76），P=0.001］；④ 4個研究報告了治療過程中的不良反應，兩組總不良反應發生率相當［OR=1.13，95%CI（0.37，3.43），P=0.83］，但伊布利特組心血管系統不良反應發生率更高［OR=2.36，95%CI（1.40，4.01），P=0.001］。
結論　伊布利特治療房顫、房撲的總轉復率和單獨治療房撲的轉復率均高于胺碘酮，且轉復房撲和房顫的時間明顯短于胺碘酮，但兩者對房顫的轉復效率相當；兩者不良反應總發生率相似，但伊布利特致心律失常的作用較胺碘酮多見。由于納入研究數量及質量有限，需要開展更多高質量隨機對照臨床試驗進一步確認。

引用本文： 董曉 ,朱賽楠,丁文惠. 伊布利特與胺碘酮轉復房顫, 房撲效果的Meta分析. 中國循證醫學雜志, 2012, 12(2): 194-200. doi: 10.7507/1672-2531.20120032 復制

1.	1 Oral H, Ozaydin M, Tada H, et al . Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation. Am J Cardiol , 2002, 90(5): 492-495.
2.	Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
3.	李春巖, 馮擇瑞. 伊布利特轉復房撲及房顫的臨床研究. 黑龍江醫學, 2009, 33(10): 732-735.
4.	胡立群, 章琦, 陳莉, 等. 伊布利特轉復老年心房顫動的臨床研究. 藥物治療學, 2009, 14 (12): 1419-1422.
5.	李颯, 周文燕, 段淑琴, 等. 中西醫結合心腦血管病雜志, 2010, 8(7): 873-874.
6.	劉飛, 張爍. 伊布利特轉復房撲/房顫的臨床觀察. 中國醫療前沿, 2010, 5(10): 23.
7.	Tai CT, Chen SA, Feng AN, et al . Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: insights into the mechanism of termination. Circulation , 1998, 97(19): 1935-1945.
8.	Bernard EO, Schmid ER, Schmidlin D, et al . Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Crit Care Med , 2003, 31(4): 1031-1034.
9.	Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10.	Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11.	Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12.	Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13.	Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14.	Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15.	Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

1. 1 Oral H, Ozaydin M, Tada H, et al . Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation. Am J Cardiol , 2002, 90(5): 492-495.
2. Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
3. 李春巖, 馮擇瑞. 伊布利特轉復房撲及房顫的臨床研究. 黑龍江醫學, 2009, 33(10): 732-735.
4. 胡立群, 章琦, 陳莉, 等. 伊布利特轉復老年心房顫動的臨床研究. 藥物治療學, 2009, 14 (12): 1419-1422.
5. 李颯, 周文燕, 段淑琴, 等. 中西醫結合心腦血管病雜志, 2010, 8(7): 873-874.
6. 劉飛, 張爍. 伊布利特轉復房撲/房顫的臨床觀察. 中國醫療前沿, 2010, 5(10): 23.
7. Tai CT, Chen SA, Feng AN, et al . Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: insights into the mechanism of termination. Circulation , 1998, 97(19): 1935-1945.
8. Bernard EO, Schmid ER, Schmidlin D, et al . Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Crit Care Med , 2003, 31(4): 1031-1034.
9. Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10. Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11. Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12. Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13. Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14. Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15. Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

《中國循證醫學雜志》

伊布利特與胺碘酮轉復房顫, 房撲效果的Meta分析

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《中國循證醫學雜志》

伊布利特與胺碘酮轉復房顫, 房撲效果的Meta分析

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