不同剂量重组组织型纤溶酶原激活剂（rt-PA）导管溶栓治疗下肢缺血疗效与安全性评价

发布时间：2018-12-25 14:47

【摘要】：目的：根据目前可以查阅到的文献资料系统评价低剂量(10mg)与高剂量(20mg)重组组织型纤溶酶原激活剂(recombinant tissue typeplasminogen activator, rt-PA)导管接触溶栓治疗下肢缺血的疗效与安全性。方法：电脑检索中国知网(1990～2013)、万方(1990～2013)、维普(1990～2013)、Cochrane图书馆、Springer Link(1990～2013)、OVID(1990～2013)、Pubmed(1990～2013)、Science Direct (1990～2013)、EBSCO(1990～2013)、EMBASE(1990～2013)等国内外数据库中关于低剂量与高剂量rt-PA导管接触溶栓治疗下肢缺血的相关随机对照试验(RCT)研究,按照纳入与排除标准进行文献筛选和质量评价后,利用Cochrane中心提供的RevMan 5.2软件对数据进行分析。结果：共纳入4篇RCT研究共360例患者,其中低剂量组192例,高剂量组168例。低剂量组与高剂量组治疗下肢缺血的疗效：2组间踝肱指数(MD=0.20,95%CI=-0.43～0.02,P=0.07)、30d患肢生存率(OR=1.05, 95%CI=0.50～2.19,P=0.90)、6个月后血管再狭窄率(OR=1.00,95%CI=0.54～1.84, P=1.00)以及穿刺后直径5cm腹股沟血肿的发生率(OR=1.26,95%CI=0.54～2.96,P=0.59)的差异均无统计学意义；但术后大出血和应激性出血的发生率高剂量组均高于于低剂量组(OR=2.58,95%CI=1.11～5.98,P=0.03:OR=2.81,95%CI=1.25～6.31, P=0.01)。结论：通过比较间踝肱指数、30d患肢生存率、6个月后血管再狭窄率等指标两种剂量rt-PA导管溶栓治疗下肢缺血疗效近似,但低剂量方案术后大出血和应激性出血等并发症的发生率明显低于高剂量方案。
[Abstract]:Objective: to evaluate the efficacy and safety of low dose (10mg) and high dose (20mg) recombinant tissue plasminogen activator (recombinant tissue typeplasminogen activator, rt-PA) catheter in the treatment of lower extremity ischemia. Methods: a computer search was conducted on the Chinese Information Network (1990 / 2013), Wanfang (1990 / 2013), Weipu (1990 / 2013), Cochrane Library, Springer Link (1990 / 2013), OVID (1990 / 2013), Pubmed (1990 /), Science Direct (1990 / 2013), EBSCO (1990 / 2013). EMBASE (1990 / 2013) and other databases at home and abroad on the low dose and high dose of rt-PA catheter contact thrombolytic therapy of lower extremity ischemia related randomized controlled trial (RCT) study, according to the inclusion and exclusion criteria for literature screening and quality evaluation. The data are analyzed by RevMan 5.2 software provided by Cochrane Center. Results: four RCT studies were included, including 192 cases in low dose group and 168 cases in high dose group. The curative effect of low dose group and high dose group on lower extremity ischemia: interankle brachial index (MD=0.20,95%CI=-0.43~0.02,P=0.07), 30-day survival rate (OR=1.05, 95CI0.502.19), There was no significant difference in the restenosis rate (OR=1.00,95%CI=0.54~1.84, Pau 1.00) and the incidence of 5cm inguinal hematoma (OR=1.26,95%CI=0.54~2.96,P=0.59) after 6 months. But the incidence of massive hemorrhage and stress hemorrhage in the high dose group was higher than that in the low dose group (OR=2.58,95%CI=1.11~5.98,P=0.03:OR=2.81,95%CI=1.25~6.31, P0. 01). Conclusion: two doses of rt-PA catheter thrombolytic therapy for lower extremity ischemia were similar by comparing the index of ankle-brachial index, 30 d limb survival rate and vascular restenosis rate after 6 months. However, the incidence of complications such as massive hemorrhage and stress hemorrhage in low dose regimen was significantly lower than that in high dose regimen.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.4
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本文编号：2391272