极化液对急性心肌梗死患者心功能影响的系统评价_《中国循证医学杂志》

作者：

杨朝辉 ¹² ,  杨克虎 ² , 马彬 ² , 尹少甫 ¹

1.兰州大学基础医学院（兰州 730000）2.兰州大学循证医学中心（兰州 730000）;

关键词：

极化液心肌梗死心功能随机对照试验系统评价

DOI：

10.7507/1672-2531.20080025

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价极化液对急性心肌梗死（AMI）患者心功能的影响。
方法　计算机检索 PubMed、EMbase、Cochrane 图书馆（2007 年第 4 期）、中国生物医学文献光盘数据库等，纳入极化液治疗 AMI 的临床随机对照试验（RCT），评价极化液治疗后患者心功能（左室射血分数、ST 段变化、左室重塑）的变化。由两名评价员独立选择试验和提取资料，并按照Cochrane 系统评价员手册的 4 条质量评价标准评价纳入文献的方法学质量，而后应用 RevMan 4.2.10 软件进行 Meta 分析。
结果　共纳入 5 个 RCT，研究地点均在国外，研究质量均较高，各试验间具有基线可比性。Meta分析结果显示：极化液治疗组较生理盐水对照组对左室射血分数的改善无差异 [WMD=1.87，95%CI（-0.32， 4.06），P=0.09]，但极化液明显有助于 ST段的下降[OR=1.92， 95%CI（1.25， 2.96），P=0.003]和阻遏心肌重构的发生 [OR=0.08，95%CI（0.01，0.68），P=0.02]。
结论　现有的证据表明，尽管极化液在一定程度上有利于 AMI 患者 ST 段的下降及远期预后，但尚不能得出极化液能改善 AMI 患者心功能的结论。今后有必要实施重点关注极化液使用时间的更为严格的大型RCT，以充分论证极化液对AMI的治疗作用。

引用本文： 杨朝辉,杨克虎,马彬,尹少甫. 极化液对急性心肌梗死患者心功能影响的系统评价. 中国循证医学杂志, 2008, 08(2): 97-101. doi: 10.7507/1672-2531.20080025 复制

1.	高润霖. 急性心肌梗死诊断和治疗指南.中华心血管病杂志, 2001, 29(12): 711.
2.	Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛宁, 译. 中国循证医学杂志, 2004, 4(6): 426.
3.	Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4.	Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5.	Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6.	Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7.	Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8.	Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9.	Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10.	Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11.	Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12.	Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13.	Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14.	Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15.	Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16.	Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17.	Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18.	Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19.	Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

1. 高润霖. 急性心肌梗死诊断和治疗指南.中华心血管病杂志, 2001, 29(12): 711.
2. Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛宁, 译. 中国循证医学杂志, 2004, 4(6): 426.
3. Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4. Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5. Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6. Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7. Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8. Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9. Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10. Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11. Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12. Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13. Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15. Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16. Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17. Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19. Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

《中国循证医学杂志》

极化液对急性心肌梗死患者心功能影响的系统评价

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《中国循证医学杂志》

极化液对急性心肌梗死患者心功能影响的系统评价

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