本文關鍵詞： Meta分析 心力衰竭 竇性心律 血栓形成　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探索竇性心律心力衰竭患者最佳的預防血栓形成的方案。方法:對PubMed、EMbase、CNKI、VIP、萬方等數(shù)據(jù)庫進行檢索,搜集有關比較竇性心律心力衰竭患者使用華法林與阿司匹林進行預防血栓形成的研究,并對搜集到的文章進行綜合定量評價,應用Rev Man5.3軟件對所收集的文獻進行Meta分析,觀察的終點事件指標包括:全因死亡、缺血性腦卒中、心肌梗死、大出血事件、中樞神經系統(tǒng)出血、小出血事件、不良胃腸道反應等。結果:共納入6篇文獻,累計病例3662例,其中華法林組1824例,阿司匹林組1838例。meta分析結果提示,在預防竇性心律心力衰竭患者血栓形成的藥物中,華法林組與阿司匹林組在全因死亡(RR=1.01,95%CI0.89~1.14,P=0.88)、心肌梗死(RR=1.09,95%CI 0.74~1.61,P=0.67)、因心衰住院(RR=0.90,95%CI 0.64~1.26,P=0.60)、中樞神經系統(tǒng)出血(RR=1.34,95%CI 0.63~2.82,P=0.45)、包括出血在內的不良胃腸道反應(RR=1.10,95%CI 0.23~5.30,P=0.91)的發(fā)生率的比較上無統(tǒng)計學差異。在缺血性腦卒中的發(fā)生率比較上,華法林顯著低于阿司匹林(RR=0.49,95%CI 0.33~0.73,P=0.0005);然而,在大出血(RR=1.93,95%CI 1.38~2.68,P=0.0001)、小出血(RR=1.37,95%CI 1.11~1.68,P=0.003)的發(fā)生率上,華法林亦明顯高于阿司匹林。結論:在預防竇性心律心力衰竭患者血栓形成的治療中,與阿司匹林相比,華法林治療后缺血性腦卒中的發(fā)生率更低,但小出血事件、大出血事件的發(fā)生率更高。
[Abstract]:Objective: to explore the best scheme to prevent thrombosis in patients with sinus heart failure. A comparative study on the use of warfarin and aspirin in prevention of thrombosis in patients with sinus heart failure was collected. The collected articles were evaluated quantitatively and analyzed by Meta using Rev Man5.3 software. The endpoint events included: total death, ischemic stroke, myocardial infarction, massive hemorrhage, central nervous system hemorrhage, small hemorrhage events, adverse gastrointestinal reactions, etc. Results: a total of 6 literatures were included, with a total of 3662 cases. The results of meta analysis in the warfarin group (1824 cases) and aspirin group (1838 cases) suggested that in the prevention of thrombosis in patients with sinus heart failure, There was no statistical difference between warfarin group and aspirin group in the incidence of RRN 1.01c95CI0.89 1.14P0.88, myocardial infarction 1.0995CI 0.749.95 CI 0.741P0.67m, RRRN 0.9095 CI 0.641.26P0.60, central nervous system hemorrhage 1.34495CI 0.632.82P0.45, including hemorrhage. There was no statistical difference in the incidence of adverse gastrointestinal reaction (RRN 1.1095CI 0.235.30P0.91). Compared with the incidence of ischemic stroke, Warfarin was significantly lower than that of Aspirin RRN 0.4995 CI 0.330.73 P0. 0005; however, warfarin was also significantly higher than aspirin in the incidence of RRN 1.9395 CI 1.38C 2.68 P0.0001, RRN 1.37 ~ 95CI 1.111.68 P0.003). Conclusion: in the treatment of prevention of thrombosis in patients with sinus heart failure, warfarin is also significantly higher than aspirin in the prevention of thrombosis in patients with sinus heart failure. Compared with aspirin, the incidence of ischemic stroke after warfarin treatment was lower, but the incidence of small hemorrhage events and massive hemorrhage events was higher.
【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】：2017
【分類號】：R541.6

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