伊布利特与胺碘酮转复房颤, 房扑效果的Meta分析_《中国循证医学杂志》

作者：

董晓 ¹ , 朱赛楠 ² ,  丁文惠 ¹

1. 北京大学第一医院心血管内科（北京 100034）；2. 北京大学第一医院统计科（北京 100034）;

关键词：

伊布利特胺碘酮心房颤动心房扑动心脏复律 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20120032

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　系统评价目前国内外伊布利特和胺碘酮治疗心房颤动、心房扑动的疗效及安全性。
方法　计算机检索PubMed、EMbase、CNKI、WanFang Data、VIP数据库和Cochrane图书馆（2011年第2期），查找1994年1月～2011年1月期间发表的所有关于伊布利特和胺碘酮转复房颤、房扑的中、英文随机对照试验（RCT）。由两位研究者按照纳入排除标准进行文献筛选、资料提取和方法学质量评价后，采用RevMan 5.0软件进行Meta 分析。
结果　最终纳入8个RCT，共计506例患者。Meta分析结果显示：① 伊布利特组转复房颤、房扑的总有效率优于胺碘酮组［OR=2.27，95%CI（1.19，4.33），P=0.01］；② 4个研究的合并分析结果显示，伊布利特组转复房颤的疗效与胺碘酮组相当［OR=1.61，95%CI（0.96，2.71），P=0.07］，但伊布利特组转复房扑的疗效更优［OR=8.97，95%CI（4.51，17.84），P lt;0.000 01］；③ 5个研究的合并分析结果显示，伊布利特组转复房颤、房扑时间明显短于胺碘酮组［WMD= –126.55 min，95%CI（–202.35，–50.76），P=0.001］；④ 4个研究报告了治疗过程中的不良反应，两组总不良反应发生率相当［OR=1.13，95%CI（0.37，3.43），P=0.83］，但伊布利特组心血管系统不良反应发生率更高［OR=2.36，95%CI（1.40，4.01），P=0.001］。
结论　伊布利特治疗房颤、房扑的总转复率和单独治疗房扑的转复率均高于胺碘酮，且转复房扑和房颤的时间明显短于胺碘酮，但两者对房颤的转复效率相当；两者不良反应总发生率相似，但伊布利特致心律失常的作用较胺碘酮多见。由于纳入研究数量及质量有限，需要开展更多高质量随机对照临床试验进一步确认。

引用本文： 董晓 ,朱赛楠,丁文惠. 伊布利特与胺碘酮转复房颤, 房扑效果的Meta分析. 中国循证医学杂志, 2012, 12(2): 194-200. doi: 10.7507/1672-2531.20120032 复制

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2.	Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
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9.	Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10.	Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11.	Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12.	Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13.	Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14.	Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15.	Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

1. 1 Oral H, Ozaydin M, Tada H, et al . Comparison of amiodarone versus ibutilide for the prevention of immediate recurrences of atrial fibrillation during pulmonary vein isolation. Am J Cardiol , 2002, 90(5): 492-495.
2. Kafkas NV, Patsilinakos SP, Mertzanos GA, et al . Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol , 2007, 118(3): 321-325.
3. 李春岩, 冯择瑞. 伊布利特转复房扑及房颤的临床研究. 黑龙江医学, 2009, 33(10): 732-735.
4. 胡立群, 章琦, 陈莉, 等. 伊布利特转复老年心房颤动的临床研究. 药物治疗学, 2009, 14 (12): 1419-1422.
5. 李飒, 周文燕, 段淑琴, 等. 中西医结合心脑血管病杂志, 2010, 8(7): 873-874.
6. 刘飞, 张烁. 伊布利特转复房扑/房颤的临床观察. 中国医疗前沿, 2010, 5(10): 23.
7. Tai CT, Chen SA, Feng AN, et al . Electropharmacologic effects of class I and class III antiarrhythmia drugs on typical atrial flutter: insights into the mechanism of termination. Circulation , 1998, 97(19): 1935-1945.
8. Bernard EO, Schmid ER, Schmidlin D, et al . Ibutilide versus amiodarone in atrial fibrillation: a double-blinded, randomized study. Crit Care Med , 2003, 31(4): 1031-1034.
9. Kirchhof P, Auricchio A, Bax J, et al . Outcome parameters for trials in atrial fibrillation: executive summary. Eur Heart J , 2007, 28(22): 2803-2817.
10. Miyasaka Y, Barnes M, Gersh B, et al . Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation , 2006, 114(2): 119-125.
11. Heeringa J, van der Kuip D, Hofman A, et al . Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J , 2006, 27(8): 949-953.
12. Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al . ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol , 2003, 42(8): 1493-1531.
13. Fuster V, Rydén LE, Cannom DS, et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Eur Heart J , 2006, 27(16): 1979-2030.
14. Fuster V, Rydén LE, Cannom DS, et al . 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol , 2011, 57(11): 101-198.
15. Sager PT. New advances in class III antiarrhythmic drug therapy. Curr Opin Cardiol , 2000, 15(1): 41-53.

《中国循证医学杂志》

伊布利特与胺碘酮转复房颤, 房扑效果的Meta分析

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《中国循证医学杂志》

伊布利特与胺碘酮转复房颤, 房扑效果的Meta分析

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