【摘要】：目的：根據(jù)目前可以查閱到的文獻資料系統(tǒng)評價低劑量(10mg)與高劑量(20mg)重組組織型纖溶酶原激活劑(recombinant tissue typeplasminogen activator, rt-PA)導(dǎo)管接觸溶栓治療下肢缺血的療效與安全性。方法：電腦檢索中國知網(wǎng)(1990～2013)、萬方(1990～2013)、維普(1990～2013)、Cochrane圖書館、Springer Link(1990～2013)、OVID(1990～2013)、Pubmed(1990～2013)、Science Direct (1990～2013)、EBSCO(1990～2013)、EMBASE(1990～2013)等國內(nèi)外數(shù)據(jù)庫中關(guān)于低劑量與高劑量rt-PA導(dǎo)管接觸溶栓治療下肢缺血的相關(guān)隨機對照試驗(RCT)研究,按照納入與排除標準進行文獻篩選和質(zhì)量評價后,利用Cochrane中心提供的RevMan 5.2軟件對數(shù)據(jù)進行分析。結(jié)果：共納入4篇RCT研究共360例患者,其中低劑量組192例,高劑量組168例。低劑量組與高劑量組治療下肢缺血的療效：2組間踝肱指數(shù)(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個月后血管再狹窄率(OR=1.00,95%CI=0.54～1.84, P=1.00)以及穿刺后直徑5cm腹股溝血腫的發(fā)生率(OR=1.26,95%CI=0.54～2.96,P=0.59)的差異均無統(tǒng)計學(xué)意義；但術(shù)后大出血和應(yīng)激性出血的發(fā)生率高劑量組均高于于低劑量組(OR=2.58,95%CI=1.11～5.98,P=0.03:OR=2.81,95%CI=1.25～6.31, P=0.01)。結(jié)論：通過比較間踝肱指數(shù)、30d患肢生存率、6個月后血管再狹窄率等指標兩種劑量rt-PA導(dǎo)管溶栓治療下肢缺血療效近似,但低劑量方案術(shù)后大出血和應(yīng)激性出血等并發(fā)癥的發(fā)生率明顯低于高劑量方案。
[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.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.4
，

本文編號：2391272