【摘要】：目的應用Meta分析的方法來評價經(jīng)導管主動脈瓣膜植入術(shù)(TAVI)治療重度主動脈瓣狹窄患者的有效性及安全性。方法SAVR為治療重度主動脈瓣狹窄的標準方法,本文探討TAVI是否不劣于SAVR。在Pubmed, The Cochrance Library, Embase三個國外主要的數(shù)據(jù)庫中進行計算機檢索,獲取已公開發(fā)表的有關(guān)TAVI與SAVR治療重度主動脈瓣狹窄患者的隊列研究。通過文獻篩選后對TAVI及SAVR術(shù)后30天全因死亡率、術(shù)后長期全因死亡率、術(shù)后心血管疾病死亡率、心肌梗死發(fā)生率、腦卒中發(fā)生率資料進行提取,然后運用STATA 11軟件對所得數(shù)據(jù)進行Meta分析。結(jié)果本篇文章最終納入2009年至2014年的17個臨床非隨機對照研究及3個臨床隨機對照研究,總計5805例樣本,其中TAVI 2844例,SAVR2961例。進行異質(zhì)性分析顯示各研究間統(tǒng)計學異質(zhì)性小,均選用固定效應模型進行Meta分析。結(jié)果顯示：TAVI組與SAVR組術(shù)后30天全因死亡率無明顯差異(RR 1.09,95%CI 0.89 to 1.33, P=0.426);在平均18.7個月的隨訪中術(shù)后長期全因死亡率無明顯差異(RR 1.05,95%CI 0.97 to 1.13,P=0.209)；在平均21.8個月的隨訪中術(shù)后心臟病死亡率無明顯差異(RR0.92,95%CI 0.69 to 1.23, p=0.582);在平均15.1個月的隨訪中術(shù)后心肌梗死發(fā)生率無明顯差異(RR 1.13,95%CI 0.51 to2.49, p=0.763);在平均12.5個月的隨訪中術(shù)后腦卒中發(fā)生率無明顯差異(RR 1.11,95%CI0.76 to1.63,P=0.581)。結(jié)論重度主動脈瓣狹窄患者TAVI與SAVR在術(shù)后30天近期生存率及平均18.7個月的長期生存率相似。TAVI與SAVR在術(shù)后心臟病死亡率及術(shù)后主要不良心腦血管事件上無顯著差異。重度主動脈瓣狹窄患者TAVI不劣于SAVR,TAVI是一種有效且安全的治療方法。
[Abstract]:Objective to evaluate the efficacy and safety of transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis by Meta analysis. Methods SAVR is the standard method for the treatment of severe aortic stenosis. This article discusses whether TAVI is not inferior to SAVR.. A cohort study on the treatment of severe aortic stenosis with TAVI and SAVR was carried out in three foreign databases of Pubmed, The Cochrance Library, Embase. The data of TAVI and SAVR mortality after 30 days, long-term mortality, cardiovascular disease mortality, myocardial infarction rate and stroke rate were extracted by literature screening. Then the data are analyzed by Meta using STATA 11 software. Results this article was included in 17 clinical non-randomized controlled trials and 3 clinical randomized controlled trials from 2009 to 2014. A total of 5805 samples were collected, including 2844 cases of TAVI and 2844 cases of SAVR2961. The heterogeneity analysis showed that the statistical heterogeneity was small and fixed effect model was used for Meta analysis. The results showed that there was no significant difference in total cause mortality between TAVI group and SAVR group 30 days after operation (RR 1.09 to 1.33, P = 0.426). There was no significant difference in long-term mortality rate between two groups (RR 1.05 鹵95 CI 0.97 to 1.13p 0.209) during an average follow-up of 18.7 months. There was no significant difference in postoperative heart disease mortality (RR0.92,95%CI 0.69 to 1.23, p0. 582) during an average of 21. 8 months follow-up. There was no significant difference in the incidence of myocardial infarction (RR 1.1395 CI 0.51 to2.49, p0. 763) during an average of 15. 1 months follow-up. There was no significant difference in the incidence of postoperative stroke (RR 1.1195 CI 0.76 to1.63,P=0.581) during an average of 12.5 months follow-up. Conclusion the short-term survival rate and the average long-term survival rate of TAVI and SAVR in patients with severe aortic stenosis were similar at 30 days and 18.7 months, respectively. There was no significant difference between TAVI and SAVR in postoperative heart disease mortality and major adverse cardiovascular and cerebrovascular events. TAVI is not inferior to SAVR,TAVI in patients with severe aortic stenosis.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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