植入式除颤器治疗肥厚型心肌病的结果的Meta分析

发布时间：2018-05-07 07:56

本文选题：肥厚型心肌病 + 植入式除颤器　；参考：《安徽医科大学》2015年硕士论文

【摘要】：研究背景:肥厚型心肌病(HCM)以心脏非对称性肥厚为特点,对患者生活质量有较大的影响,心源性猝死(SCD)是其重要的死亡原因,猝死最常见的原因是室性快速心律失常,因而及时终止恶性心律失常可以有效地降低患者的猝死发生率。越来越多的资料证明,ICD是恶性室性心律失常的首选治疗措施,最近ICD越来越多被用于预防肥厚型心肌病患者发生心脏性猝死,但是单个研究病例数较少,观察指标多样,对其疗效以及患者的选择仍未完全明确,所以我们需要大量的循证医学证据证实ICD治疗HCM的疗效及并发症的发生率。研究目的:使用循证医学中通用的系统评价法,对植入式除颤器(ICD)治疗肥厚型心肌病(HCM)的相关临床研究进行Meta分析,以系统阐明植入式除颤器在肥厚型心肌病治疗中的临床获益,并评估ICD治疗HCM的预后。研究方法:遵循循证医学方法,系统检索至2014年8月Pub Med数据库,EMbase数据库,中国学术期刊全文数据库,重庆维普数据库,万方数据库。对纳入疾病的检索,中文数据库中为“肥厚型心肌病”,外文数据库中为“hypertrophic cardiomyopathy”。对治疗策略的检索,中文数据库中检索词为“植入式除颤器”或“埋藏式心律转复除颤器”,外文数据库中检索词为“implantable cardioverter defibrillator”。按照纳入与排除标准,由两人分别阅读文献并提取资料,采用stata10.0软件对数据进行Meta分析。结果:在Pub Med数据库、EMbase数据库中共搜索到基于19个ICD治疗HCM患者队列的30个研究报告;而中国学术期刊全文数据库、万方数据库及重庆维普均没有检索到相关文献。对ICD干预、死亡率进行提取、合并和分析。2621名患者经过随访,心血管年死亡率为0.6%,非心血管年死亡率为0.8%,恰当的ICD干预率为4.1%/年,不恰当的ICD干预率为4.9%/年。结论:分析后发现植入ICD治疗肥厚型心肌病后患者的心脏死亡率和非心脏死亡率低,恰当的ICD干预率为4.1%/年,可以认为植入式除颤器治疗肥厚型心肌病能有效预防猝死。
[Abstract]:Background: hypertrophic cardiomyopathy (HCM) is characterized by asymmetric hypertrophy of the heart, which has a great influence on the quality of life. Sudden cardiac death (SCDD) is an important cause of death, and the most common cause of sudden death is ventricular tachyarrhythmia. Therefore, timely termination of malignant arrhythmia can effectively reduce the incidence of sudden death in patients. More and more data show that ICD is the first choice of treatment for malignant ventricular arrhythmia. Recently, ICD has been used more and more to prevent sudden cardiac death in patients with hypertrophic cardiomyopathy. The efficacy and choice of patients are still not fully defined, so we need a large amount of evidence-based medical evidence to confirm the efficacy and incidence of complications of ICD in the treatment of HCM. Objective: to analyze the clinical study of the treatment of hypertrophic cardiomyopathy with implantable defibrillator (ICD) by using the general system evaluation method in evidence-based medicine (Evidence-based medicine). The clinical benefits of implantable defibrillators in the treatment of hypertrophic cardiomyopathy and the prognosis of ICD in the treatment of HCM were systematically elucidated. Methods: according to the method of evidence-based medicine, Pub Med database, full text database of Chinese academic journal, Chongqing Weipu database and Wanfang database were searched to August 2014. The Chinese database was "hypertrophic cardiomyopathy" and the foreign language database was "hypertrophic cardiomyopathy". For the retrieval of treatment strategy, the key words in Chinese database are "implantable defibrillator" or "buried cardioverter defibrillator", and in foreign language database the key word is "implantable cardioverter defibrillator". According to the criteria of inclusion and exclusion, the two people read the literature and extracted the data separately. The data were analyzed by Meta with stata10.0 software. Results: a total of 30 research reports based on 19 ICD treatment cohorts of HCM patients were found in the Pub Med database, while none of the related literatures were found in the full text database of Chinese academic journals, Wanfang database and Chongqing Weipu database. ICD intervention, mortality rate were extracted, followed up by combining and analyzing .2621 patients. The cardiovascular mortality rate was 0.6, the non-cardiovascular mortality rate was 0.8, the appropriate ICD intervention rate was 4.1 per year, and the inappropriate ICD intervention rate was 4.9 per year. Conclusion: the cardiac mortality and non-cardiac mortality of patients with hypertrophic cardiomyopathy treated with ICD implantation are low, and the appropriate intervention rate of ICD is 4.1 / year. It can be concluded that implantable defibrillator can effectively prevent sudden death in patients with hypertrophic cardiomyopathy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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