本文選題：急性心肌梗死 + 經(jīng)皮冠狀動脈介入　； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:本研究采取Meta分析綜合概括急性心肌梗死患者急診PCI術(shù)中發(fā)生無復(fù)流的臨床常見影響因素及其關(guān)聯(lián)強度,主要包括:(1)中性粒細胞/淋巴細胞比值(NLR);(2)合并2型糖尿病;(3)合并低血壓;(4)發(fā)病-再灌注時間延長;(5)無側(cè)支循環(huán)形成;(6)血栓負荷重;(7)hsCRP升高;(8)多支架置入;(9)多支病變,綜合分析上述危險因素與無復(fù)流發(fā)生的相關(guān)性,為無復(fù)流的預(yù)測及預(yù)防提供可靠的循證學(xué)依據(jù)。方法:嚴格按照Cochrane協(xié)作網(wǎng)對文獻檢索的要求,通過Pubmed、Springer、Cochrane、學(xué)引文檢索(SCI)、Embase、Medline、CNKI、萬方、維普等數(shù)據(jù)庫進行檢索無復(fù)流相關(guān)危險因素,盡可能全面收集本研究文獻,檢索時間范圍為2002年1月至2017年1月,將中文及英文限定為篩選語種。采用系統(tǒng)綜述分析所納入的文獻,效應(yīng)量采用比值比(OR)表示,各效應(yīng)量區(qū)間范圍采用95%CI表示,各研究之間的異質(zhì)性分析采用Q檢驗。最終納入臨床常見的9個無復(fù)流危險因素:(1)中性粒細胞/淋巴細胞比值(NLR);(2)合并2型糖尿病;(3)合并低血壓;(4)發(fā)病-再灌注時間延長;(5)無側(cè)支循環(huán)形成;(6)血栓負荷重;(7)hsCRP升高;(8)多支架置入;(9)多支病變,納入有價值的原始數(shù)據(jù),最終使用RevMan5.3統(tǒng)計軟件進行Meta分析。結(jié)果:依據(jù)納入標準,通過一系列篩選后最終納入20篇與無復(fù)流危險因素相關(guān)的文獻,中文8篇,英文12篇。Meta分析結(jié)果如下:1.NLR值:合并效應(yīng)量OR值為1.27,95%CI(0.89,1.66),P0.05。2.合并2型糖尿病:合并效應(yīng)量OR值為14.77,95%CI(11.50,18.98),P0.05。3.合并低血壓:合并效應(yīng)量OR值為10.00,95%CI(5.06,19.77),P0.05。4.發(fā)病-再灌注時間:合并效應(yīng)量OR值為4.94,95%CI(4.70,5.18),P0.05。5.無側(cè)支循環(huán):合并效應(yīng)量OR值為17.22,95%CI(13.87,21.39),P0.05。6.血栓負荷:合并效應(yīng)量OR值為13.94,95%CI(10.24,18.99),P0.05。7.hsCRP:合并效應(yīng)量OR值為10.57,95%CI(9.93,11.20),P0.05。8.多支架置入:合并效應(yīng)量OR值為13.89,95%CI(10.27,18.77),P0.05。9.多支病變:合并效應(yīng)量OR值為7.83,95%CI(6.28,9.75),P0.05。結(jié)論:目前臨床上對于無復(fù)流的病因及發(fā)病機制尚無明確定論,本研究對無復(fù)流的臨床常見危險因素進行Meta分析后認為,中性粒細胞/淋巴細胞比值(NLR)、合并2型糖尿病、合并低血壓、發(fā)病-再灌注時間延長、無側(cè)支循環(huán)形成、血栓負荷重、hs CRP升高、多支架置入及多支病變是無復(fù)流現(xiàn)象的危險因素,關(guān)聯(lián)強度由強至弱為:無側(cè)支循環(huán)、合并2型糖尿病、血栓負荷、多支架置入、hsCRP、合并低血壓、多支病變、發(fā)病-再灌注時間、NLR。利用以上結(jié)論,在臨床工作中可以預(yù)測及預(yù)防無復(fù)流的發(fā)生,為應(yīng)對無復(fù)流的發(fā)生提供應(yīng)對空間。
[Abstract]:Objective: in this study, Meta-analysis was used to summarize the common clinical factors and the associated strength of the patients with acute myocardial infarction (AMI) who had no reflow during emergency PCI. These include: 1) neutrophil / lymphocyte ratio (NLRX 2) with type 2 diabetes mellitus (3) complicated with hypotension (4) pathogenesis-reperfusion time prolongation (n = 5) No collateral circulatory formation (n = 6) thrombus load: 7? s CRP elevated? The correlation between the above risk factors and the occurrence of no reflow was comprehensively analyzed in order to provide a reliable evidence-based basis for the prediction and prevention of non-reflow. Methods: according to the requirements of Cochrane Cooperative Network for literature retrieval, the relevant risk factors of no reflow were retrieved by Pubmedmeda Springerus Cochraneand Citation search in CNKI, Wanfang, Wiper and other databases, so as to collect the relevant literature as comprehensively as possible. The retrieval time ranges from January 2002 to January 2017, and the Chinese and English languages are limited to the selected languages. The literature included in this paper is systematically reviewed and analyzed, the effect quantity is expressed by ratio, the range of each effect quantity is expressed by 95 CI, and the heterogeneity of each study is analyzed by Q test. The nine common clinical risk factors without reflow, 1: 1) neutrophil / lymphocyte ratio (NLRR1) 2) with type 2 diabetes mellitus (3) complicated with hypotension (4) pathogenesis-reperfusion time prolongation, (5) collateral circulation formation and thrombotic load (6) were included in the clinical trial of 9 common risk factors of no reflow (1: 1) neutrophil / lymphocyte ratio (2) type 2 diabetes mellitus (3) and hypotension. Multiple stents were placed in 9) multivessel lesions. Incorporating valuable raw data and eventually using RevMan5.3 statistical software for meta-analysis. Results: according to the inclusion criteria, 20 articles related to no risk factors of reflow were selected, 8 in Chinese and 12 in English. The results of Meta analysis were as follows: 1. NLR value: OR value of combined effect was 1. 2795 CIQ 0.89 / 1. 66% P 0. 05.2. Type 2 diabetes mellitus: the OR value of the combined effect volume was 14.77% 95% CI 11.50 ~ 18.98% P0.05.3. Combined hypotension: OR value of combined effect was 10.00 ~ 95CIQ 5.06 ~ 19.77% P0.05.4. The incidence and reperfusion time: the OR value of the combined effect was 4.94% 95% CI: 4.70% 5.18% P0.05.5%. No collateral circulation: the OR value of the combined effect was 17.22 / 95 CIQ 13.87 ~ 21.39% (P0.05.6). Thrombus load: the OR value of combined effect was 13.94% 95% CI 10.24 ~ 18.99 ~ 18.99% P 0.05.7.hs CRP0.The OR value of combined effect was 10.57 鹵95% CI 9.93% 11.20% P 0.05.8. Multiple stent placement: the OR value of combined effect was 13.89 鹵95CI 10.27 ~ 18.77% P 0.05.9. Multivessel lesion: the OR value of combined effect was 7.83% 95% CI 6.289.75% P0.05. Conclusion: at present, there is no definite conclusion on the etiology and pathogenesis of non-reflow in clinic. After meta-analysis of the common clinical risk factors of non-reflux, it is concluded that the neutrophil / lymphocyte ratio (NLRN) may be associated with type 2 diabetes mellitus (T2DM). Associated hypotension, prolonged duration of pathogenesis-reperfusion, formation of no collateral circulation, elevated hs CRP under heavy thrombus load, multi-stent implantation and multi-vessel lesion were risk factors of no-reflow phenomenon. The correlation strength from strong to weak was as follows: no collateral circulation. Patients with type 2 diabetes mellitus, thrombus load, multiple stents implanted with hsCRP, hypotension, multiple vessel lesions, pathogenesis-reperfusion time and NLR. Using the above conclusions, we can predict and prevent the occurrence of no reflow in clinical work, and provide a response space for the occurrence of no reflow.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.22

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本文編號：2022048