摘要
目的比较第1代与第2代冷冻球囊冷冻消融治疗心房颤动(房颤)的安全性及有效性。方法检索建库至2015年2月27日Pubmed、CBM、CENTRAL、the ISI Web of Knowledge Data-bases、CNKI、EMbase、VIP和万方数据库所有与第1代和第2代冷冻球囊冷冻消融治疗房颤相关的病例对照研究,同时检索相关文献参考文献,依据纳入排除标准等对文献进行筛选,提取相关资料,进行文献质量评价,采用Rev Man 5.1统计软件进行meta分析。结果最终纳入合格文献10篇1441例。meta分析结果显示第2代组手术时间[SMD=1.27,95%CI(0.97,1.57),P<0.00001]、术中消融时间[SMD=0.67,95%CI(0.50,0.84),P<0.00001]、X线暴露时间[SMD=1.25,95%CI(1.12,1.39),P<0.00001]短于第1代组,冷冻消融次数/肺静脉[SMD=0.75,95%CI(0.28,1.22),P=0.002]少于第1代组,即刻肺静脉隔离(pulmonary vein isolation,PVI)成功率[OR=0.47,95%CI(0.30,0.74),P=0.001]高于第1代组,术中与术后膈神经麻痹(phrenic nerve paralysis,PNP)发生率[OR=0.44,95%CI(0.24,0.82),P=0.009]高于第1代组,差异均具有统计学意义。结论第2代冷冻球囊冷冻消融治疗房颤不仅能够缩短手术时间、消融时间、X线暴露时间,还能减少冷冻消融次数,提高PVI成功率,但其PNP发生率明显高于第1代,需引起重视。
Objective To compare the efficacy and safety of the first generation （G1） cryoballon and second genera-tion （G2） cryoablation in treatment of atrial fibrillation （AF）. Methods Databases such as Pubmed, CBM, CENTRAL, the ISI Web of Knowledge Data-bases, CNKI, Embase, VIP and Wanfang were searched from their establishment to February 27 2015 for collecting the case-control studies about G1 cryoballon Versus G2 cryoballon for the treatment of AF and the refer-ences of those case-control studies were also included. The literature was screened according to inclusive criteria, data were extracted and the quality of included studies was assessed, and then meta-analysis was performed with Rev Man 5. 1 software. Results 10 studies involving 1441 patients were included. The meta-analysis showed that： compared with G1 group, G2 group took shorter operation time [SMD=1. 27,95%CI （0. 97,1. 57）, P〈0. 00001], shorter ablation time[SMD=0. 67, 95%CI （0. 50,0. 84）, P〈0. 00001] and fluoroscopy time [SMD=1. 25,95%CI （1. 12,1. 39）, P〈0. 00001]. G2 group needed less total number of applications [SMD=0. 75,95% CI （0. 28,1. 22）, P=0. 002]. The success rate of immediate PVI in G2 group was higher than that in G1 group [OR=0. 47,95%CI （0. 30,0. 74）, P=0. 001]. The rate of PNP was sig-nificantly higher in G2 group [OR=0. 44,95%CI （0. 24,0. 82）, P=0. 009]. Conclusion Compared with G1, using G2 ablation in treating AF not only takes shorter time of surgery, cryoablation, less X-ray exposure and shorter ablation time, but also increases PVI success rate. But we should also notice that the incidence of PNP is significantly higher than that of the first generation cryoballon.
出处
《临床误诊误治》
2015年第11期84-90,共7页
Clinical Misdiagnosis & Mistherapy
