心房颤动患者节律控制与室率控制预后比较的荟萃评价

摘要

Objective To evaluate the difference of prognosis between rhythm control and rate control in patients with atrial fibrillation. Methods We searched the Pubmed(2000 -2010) , Medline(2000 -2010) , Cochrane Database of Systematic Reviews(2000 -2010) ,Embase(2000 -2010) to collect randomized controlled trials( RCTSs). The quality of RCTSs was critically appraised and data were extracted by reviewers independently. Meta analyses were conducted for the eligible RCTSs. Results Six RCTSs were included. For the endpoints of death, ischaemic stroke and non - CNS bleeding, there was no significant difference from the RCTSs. Conclusion Compared to rhythm control, rate control could decrease the risk of hospitalization and not increase the risk of other adverse endpoints. Optimizing rate control and more widespread and effective anticoagulation are a good treatment for atrial fibrillation.%目的 评价房颤患者节律控制与室率控制2种治疗方法预后有无差异.方法 计算机检索Pubmed(2000～2010)、Cochrane Database of Systematic Reviews( 2000～2010)、EMbase(2000～2010)中关于心房颤动患者节律控制与室率控制预后进行比较的随机对照研究(RCTs),同时筛检纳入文献的参考文献,对纳入研究的方法学进行评价.研究者对文献质量进行严格评价和资料提取,对符合质量标准的RCTs用Revman 5.0软件进行荟萃分析.结果 6个RCTs共6615名患者纳入研究,其中节律控制组(节律组)3312例,室率控制组(室率组)3303例.荟萃分析结果表明房颤患者节律组再次住院人数高于室率组.对于心房颤动患者节律组与室率组在全因总病死率、发生缺血性脑卒中、发生非中枢神经系统性出血方面相关的RCTs结果显示无显著差异.结论 与控制心房颤动的节律相比,控制心室率可以降低患者住院次数但不增加发生其他不良结局的危险性.控制心室率、联合使用抗凝药可以作为心房颤动患者的治疗方案.