摘要
目的比较艾司洛尔与胺碘酮治疗心房颤动(房颤)伴快速心室率合并Ⅰ至Ⅲ级心力衰竭(心衰)患者的有效性和安全性。方法计算机检索Pubmed、Embase、Cochrane、CNKI、VIP和Wanfang等数据库,时限是从建库至2020年10月21日。获取艾司洛尔和胺碘酮治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰的随机对照研究(randomized controllled trial,RCT)。应用RevMan5.4软件对药物有效率和不良反应率进行Meta分析。将纳入患者分为艾司洛尔组和胺碘酮组,研究终点为心室率降低>20%、心室率降至100次/min以下、心室率降低<20%或心室率仍在100次/min以上。比较房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者经艾司洛尔和胺碘酮治疗的有效率及安全性。结果共纳入7项RCT研究,包括576例患者,其中艾司洛尔组238例(50%),胺碘酮组238例(50%)。Meta分析结果显示,在用药的5~15min中,艾司洛尔组的治疗有效率(51.66%)高于胺碘酮组(9.96%)(RR=4.92,95%CI:3.34~7.27,P<0.00001);在用药30min时,艾司洛尔组的治疗有效率(73.52%)高于胺碘酮组(49.16%)(RR=1.48,95%CI:1.25~1.74,P<0.00001);在用药的120min时,艾司洛尔组的治疗有效率(86.74%)与胺碘酮组(89.2%)差异无统计学意义(RR=0.99,95%CI:0.92~1.06,P=0.86);在整个治疗过程中,艾司洛尔组和胺碘酮组出现低血压、低心率、胃肠道症状等不良反应事件率的差异无统计学意义(RR=1.65,95%CI:0.92~2.84,P=0.80)。结论艾司洛尔和胺碘酮在治疗房颤伴快速心室率合并Ⅰ至Ⅲ级心衰患者时,用药30min内,艾司洛尔控制心室率的有效率显著高于胺碘酮,但总有效率(用药120min时)无差异,且两药在治疗过程中出现低血压、低心率及胃肠道症状等不良反应事件率也无差异。
Objective To compare the efficacy and safety of esmolol and amiodarone in patients with atrial fibrillation(AF)with rapid ventricular rate and heart failure gradeⅠtoⅢ.Methods Randomized controlled trials(RCT)on esmolol and amiodarone for atrial fibrillation with rapid ventricular rate and gradeⅠtoⅢheart failure were searched in PubMed,EMBASE,Cochrane,CNKI,VIP and Wanfang databases from inception to October 21,2020.Meta-analysis of drug response rates and adverse effect rates was performed using revman5.4 software.Patients were divided into esmolol group and amiodarone group.The study endpoints were a ventricular rate reduction>20%,a ventricular rate reduction below 100 beats/min,a ventricular rate reduction<20%or a ventricular rate remaining above 100 beats/min.The efficacy and safety of esmolol and amiodarone in patients with AF and rapid ventricular rate complicated by gradesⅠtoⅢheart failure were compared.Results A total of seven RCT studies comprising 576 patients were included,of which 238(50%)were assigned to the esmolol group and 238(50%)to the amiodarone group.The results of the meta-analysis showed that the esmolol group had a better treatment response rate(51.66%)than the amiodarone group(9.96%)at 5~15 min(RR=4.92,95%CI:3.34~7.27,P<0.00001)and a higher efficacy rate(73.52%)than the amiodarone group(49.16%)at 30 min(RR=1.48,95%CI:1.25~1.74,P<0.00001).However,at 120 min after medication,there was no significant difference in treatment response rate between esmolol group(86.74%)and amiodarone group(89.2%)(RR=0.99,95%CI:0.92~1.06,P=0.86).There were no significant differences in the rates of adverse events including hypotension,low heart rate,or gastrointestinal symptoms between the two groups during the whole treatment period(RR=1.65,95%CI:0.92~2.84,P=0.80).Conclusion Within 30 min of administration,the response rate to control ventricular rate of esmolol was higher than that of amiodaronein patients with atrial fibrillation with rapid ventricular rate and gradeⅠtoⅢheart failure.However,ther
作者
刘鹏
王广新
杨阳
苏国海
LIU Peng;WANG Guang-xin;YANG Yang;SU Guo-hai(Department of Cardiology,Affiliated Central Hospital of Shandong First Medical University,Jinan 250013,China)
出处
《中国心血管病研究》
CAS
2021年第4期307-312,共6页
Chinese Journal of Cardiovascular Research
基金
国家科技重大专项课题(2020ZX09201025)。
