以右室起搏对心功能影响为例探析META研究方法.docx

以右室起搏对心功能影响为例探析META研究方法 摘要：目的该篇META分析比较右室非心尖部起搏 (RVNAP)和心尖部起搏(RVAP)对心功能的影响。方法检 索 MEDLINE 、 EMBASE 和 Cochrane Controlled Trials Register数据库，收集随访时间22个月的随机对照试验。 结果20个试验包括1114例患者入选。与RVAP相比，RVNAP 不仅在起搏阈值及R波感知方面表现优异，左室射血分数在 随访末也明显升高。结论RVNAP在电极参数方面表现出令人 满意的长期结果，并在6个月随访后，提高左室射血分数方 面作用有利。 关键词：META分析；右室非心尖部起搏；心功能；文献 检索 中图分类号：Rl, R4 Taki ng an Example of the Effects of Righ t Ventricular Pacing on Cardiac Function to Discuss META Analysi WANG Wei-zongl, YIN Xiang-cui2, ZHANG Yu-jiaol (1. Shandong University, Jinan 250014, Shandong, China； 2. Shandong Qianfoshan Hospital, Jinan 250014, Shandong, China) Abstract： Objective A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effects of right ventricular nonapical (RVNA) and right ventricular apical (RVA) pacing on cardiac function. Methods A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Library to identify RCTs comparing RVNA pacing with RVA pacing with follow-up 22 months? ResuIts Twenty RCTs involving 1, 114 patients were included. Compared with RVA pacing, RVNA pacing exhibited not only excellent pacing threshold and R-wave amplitude but also higher impedance. RVNA pacing showed a significant increase in left ventricular ejection fraction (LVEF) at the end of follow-up. Conclusion This meta-analysis found that RVNA pacing exhibited satisfactory long-term lead performanee compared with RVA pacing and demonstrated beneficial effects in improving LVEF after the 6~month follow-up. Key words : META Analysis ； Right Ventricular Nonapical Pacing ； Cardiac Function ； Literature Retrieval 自从心脏起搏器问世以来[1],因为右室心尖部易于识 别并且心尖部起搏具有良好的电极稳定性等优点，右室心尖 部起搏（RVAP） —直被认为是治疗症状性病态窦房结综合征 或慢性高度房室传导阻滞中安装临时或永久心脏起搏器的 首要选择［2］。然而，越来越多的研究表明，长期RVAP改 变了心室激动顺序，引起节段性室壁运动异常，损害了左室 收缩及舒张功能，增加了心衰的发生率和死亡率，这将会抵 消其潜在的优势［3?5］。因此，寻找一个具有同步化心室 激动顺序的起搏位点从未间断，并且一系列的右心室非心尖 部起搏位点被发现［6, 7］,但是，既往关于不同起搏位点 的研究得到了不一致的结果［8?11］。在以前的荟萃分析 中，de Cock ［12］发现右室非心尖部起搏（RVNAP）较RVAP 在血流动力学方面有了很大提高。最近，另一项涉及14个 随机对照试验的荟萃分析［13］指