摘要
目的比较静脉注射地尔硫卓、美托洛尔控制房颤快速心室率疗效和安全性。方法检索Pub Med、EMbase、Cochrane Library、Web of Science、CNKI、VIP、CBM和万方数据库,收集所有比较地尔硫卓、美托洛尔治疗房颤快速心室率的随机对照试验（RCTs）,检索时间均为各数据库建库时间至2015年10月。按照纳入和排除标准由2名评价者独立筛选并提取资料,采用Cochrane 5.1手册提供的偏倚风险评估方法,对纳入研究进行质量评价后,使用Rev Man 5.3软件进行Meta分析。结果共纳入6项研究,共366例患者。Meta分析结果显示：1有效性方面：地尔硫卓控制房颤快速心室率与美托洛尔相比总有效率无明显差异[相对危险度（RR）=1.12,95%可信区间（CI）：0.96~1.31,P=0.14],房颤心室率下降幅度地尔硫卓组优于美托洛尔组[加权均数差（MD）=10.01,95%CI：3.95~16.07,P=0.001],平均起效时间两者无明显差别（MD=-0.50,95%CI：-1.68~0.67,P=0.40）;2安全性方面：不良反应（包括收缩压〈12.0 k Pa、心室率〈60次/min）发生率两者相比差异无统计学意义[率差（RD）=-0.00,95%CI：-0.04~0.04,P=0.89]。结论现有研究显示,地尔硫卓与美托洛尔控制房颤快速心室率的总有效率、平均起效时间及安全性方面无差异,但地尔硫卓心室率下降幅度更大。因受纳入研究数量及部分研究质量限制,该结论尚需开展更多大样本、多中心的随机对照试验加以验证。
Objective To compare the efficacy and safety of intravenous diltiazem and metoprolol for the control of rapid ventricular rate in patients with atrial fibrillation. Methods The databases of Pub Med,EMbase,Cochrane Library,Web of Science,CNKI,VIP,CBM and Wan fang were retrieved with computer from their establishment to Oct. 2015 for collecting randomized controlled trials（ RCTs） about comparison in curative effect and safety of diltiazem and metoprolol in treatment of atrial fibrillation with rapid ventricular rate. The data were screened and extracted by two independent reviewers according to inclusion and exclusion criterions. The bias risk assessment method,which was provided by the Cochrane5. 1 Handbook,was used to evaluate the quality of the included studies,and then a Meta-analysis was conducted by using Rev Man 5. 3 software. Results There were totally 6 RCTs included involving 366 patients. The results of Meta-analysis showed that： 1 efficacy indicators： there was no significant difference between diltiazem and metoprolol for the control of rapid ventricular rate in atrial fibrillation of total effective rate（ RR = 1. 12,95% CI： 0. 96 ~ 1. 31,P = 0. 14） and mean onset time（ MD =-0. 50,95% CI：-1. 68 ~0. 67,P = 0. 40）,while ventricular rate decreased amplitude of diltiazem group was more than metoprolol group（ MD = 10. 01,95% CI： 3. 95 ~ 16. 07,P = 0. 001）. 2 safety indicators： both of the adverse reactions（ including systolic blood pressure 〈12. 0 k Pa,heart rate 〈60 bpm） incidence rate showed no significant difference（ RD =-0. 00,95% CI：-0. 04 ~ 0. 04,P = 0. 89）. Conclusion The existing evidence shows that diltiazem has no differece in total effective rate,mean onset time and safety compared with metoprolol in treatment of atrial fibrillation with rapid ventricular rate,but it has a greater ventricular rate decreased amplitude. This study is limited by the quantity and quality of included literature,and it is necessary to carry out more strictly-designed,large-samp
出处
《安徽医科大学学报》
CAS
北大核心
2016年第9期1297-1302,共6页
Acta Universitatis Medicinalis Anhui
基金
安徽高校自然科学研究项目(编号:KJ2015ZD24)
