心肺复苏后心电图诊断急性心肌梗死荟萃分析.docVIP

心肺复苏后心电图诊断急性心肌梗死荟萃分析 　　【摘要】目的 探讨心搏骤停患者复苏后心电图ST段抬高诊断急性心肌梗死（acute myocardial infarction，AMI）的作用。方法 收集1990年1月至2012年10月心肺复苏后自主循环恢复的患者，排除明显心脏外因素后急诊行冠状动脉造影的前瞻性或回顾性病例研究文献，利用Meta-disc1.4软件对所提取的心电图及冠脉造影结果等相关数据进行分析。结果 共纳入5篇文献，包括1017例患者，均为连续性病例回顾研究，Meta分析示心电图ST段抬高诊断AMI的敏感度（SEN）0.59，特异度（SPE）0.86，阳性似然比（+LR）4.4，阴性似然比（-LR）0.39，诊断比值比（DOR）12.28，曲线下面积（AUC） 0.85。结论 心搏骤停心肺复苏后自主循环恢复患者心电图ST段抬高对于诊断AMI特异性高，但是敏感度低，整体诊断价值不高。 　　【关键词】心肺复苏后；心电图；急性心肌梗死；Meta分析 　　The diagnostic value of ST-segment elevation in acute myocardial infarction in patients after resuscitation： a meta-analysis WANG Shu-peng， QIN Li-jie. Emergency Department， Henan Provincial People’s Hospital， Zhengzhou University， Zhengzhou 450003， China 　　Corresponding author： QIN Li-jie， Email： qinlijie1819@163.com 　　【Abstract】Objective To investigate the diagnostic value of ST segment elevation in acute myocardial infarction （AMI） occurred in patients after resuscitation.Methods The relevant articles about coronary angiography performed in an emergency for all the post-resuscitation patients without obvious non-cardiac cause， regardless of the representation of the electrocardiography were searched in the databases of Pubmed， Ovid medline， EBSCO， CBM， Wanfang and VIP of Chongqing. The meta-analysis was carried out with the data from the included articles using the meta-disc 1.4 software. Results Five articles about retrospective analysis of consecutive patients were included. The meta-analysis of pooled statistics showed the sensitivity 0.59， the specificity 0.86， the positive likelihood ratio （LR） 4.4， the negative LR 0.39， the diagnostic odds ratio （OR） 12.28 and the area under the curve （AUC） 0.85. Conclusions Although the high specificity is in favor of making diagnosis of AMI in post-resuscitation patients， the low sensitivity makes the integrative diagnostic value of using sole ST-segment elevation of ECG relatively low. 　　【Key words】Post cardiopulmonary resuscitation； Electrocardiography； Acute myocardial infarction； Met