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目的评价远程缺血预处理(RIPC)对经皮冠状动脉介入(PCI)术患者术后心肌保护的效果。方法计算机检索Pub Med、Web of Science、Cochrane Library数据库中有关RIPC对PCI手术后成年患者心肌保护作用的随机对照试验。干预措施为RIPC组给予数次上肢或下肢的缺血再灌注预处理,对照组无任何缺血预处理。主要观察指标为PCI术后主要心血管事件(MACE)、心肌梗死及不同部位RIPC后MACE的发生率。采用Rev Man5.2软件进行Meta分析。结果 11篇文献纳入研究,其中RIPC组961例,对照组951例。Meta分析显示RIPC组MACE、心肌梗死发生率明显低于对照组(P<0.05);在上肢的RIPC与下肢的RIPC的亚组分析中,两组的术后MACE发生率均低于对照组(P<0.05)。结论RIPC可以减少PCI患者术后MACE、心肌梗死的发生率,对心肌有明显的保护作用。
Objective To evaluate the effect of remote ischemic preconditioning (RIPC) on postoperative myocardial protection in patients undergoing percutaneous coronary intervention (PCI). Methods We searched the Pub Med, Web of Science, Cochrane Library database for randomized controlled trials of RIPC on cardioprotection in adult patients with PCI. Interventions were given to RIPC group several times of ischemic reperfusion pre-treatment of upper limbs or lower limbs, the control group without any ischemic preconditioning. MAIN OUTCOME MEASURES: The incidence of major cardiovascular events (MACE), myocardial infarction and post-RIPC MACE after PCI. Meta-analysis was performed using Rev Man 5.2 software. Results Eleven articles were included in the study, including 961 in the RIPC group and 951 in the control group. Meta-analysis showed that the incidence of MACE and myocardial infarction in RIPC group was significantly lower than that in control group (P <0.05). In subgroup analysis of RIPC of upper limbs and RIPC of lower limbs, postoperative MACE incidence of both groups were lower than that of control group P <0.05). Conclusion RIPC can reduce the incidence of postoperative MACE and myocardial infarction in PCI patients, and has a significant protective effect on myocardium.