目的 系統(tǒng)評價早期應用替羅非班對急性ST段抬高型心肌梗死（STEMI）經(jīng)皮冠狀動脈介入（PCI）術后冠脈血流及并發(fā)癥影響。方法 檢索PubMed、Embase、Cochrane圖書館、中國學術期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學文獻數(shù)據(jù)庫（CBM）和維普中文期刊全文數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫關于STEMI患者急診行PCI并早期應用替羅非班的臨床對照研究（RCT），檢索年限均為建庫起至2020年4月30日。試驗組為PCI術前開始應用替羅非班，對照組為PCI術中或術后應用替羅非班，數(shù)據(jù)提取和質(zhì)量評價，應用RevMan 5.3軟件進行Meta-分析。結果 共納入15項RCT，共計2 214例患者。Meta-分析結果顯示，術前應用替羅非班組較術中或術后用藥組，PCI術后TIMI血流分級為3級（RR=1.10，95%CI=1.06~1.15，P<0.01）和（RR=1.10，95%CI=1.03~1.17，P<0.01）、ST段下落幅度（SMD=0.44，95%CI=0.17~0.70，P=0.001）和（SMD=1.85，95%CI=1.53~2.17，P<0.01）、ST段回落率（RR=1.51，95%CI=1.20~1.89，P<0.01）和（RR=1.20，95%CI=1.05~1.39，P=0.01）均顯著優(yōu)于術中或術后用藥；術前應用組提高左心室射血分數(shù)（LVEF%）（SMD=0.46，95%CI=0.13~0.79，P=0.007）和降低主要心血管不良事件（MACE）發(fā)生率（RR=0.53，95%CI=0.39~0.73，P<0.01）均優(yōu)于術中用藥組。術前應用組與術后應用組的LVEF%和MACE發(fā)生率比較均無顯著性差異。術前應用組出血及并發(fā)癥發(fā)生率與術中及術后應用組比較均無顯著性差異。結論 與PCI術中及術后應用替羅非班相比，術前應用更能顯著改善STEMI患者微循環(huán)障礙、增加心肌組織有效的再灌注、減少心肌梗死范圍。

Objective To investigate the effect of early using titrofiban on blood flow and complications in patients with Acute STsegment elevation myocardial infarction (STEMI) after Percutaneous coronary intervention (PCI). Methods Randomized controlled clinical trials (RCTs) of early using titrofiban in STEMI patients with emergency PCI from database establishment to 30th April of 2020 were retrieved from PubMed, Embase, Cochrane library, CNKI, CBM, VIP and Wanfang database. The test group was given titrofiban before PCI, and the control group was given titrofiban during or after PCI. Meta-analysis were performed with RevMan 5.3 software. Results A total of 15 RCTs studies were finally included and involving 2 214 patients. Meta-analysis showed that, compared with the intra-operative application groups and post-operative application groups, the pre-operative application groups significantly improved the thrombolysis in myocardial infarction (TIMI) classification to 3 after PCI (RR=1.10, 95%CI=1.06 to 1.15, P<0.01) and (RR=1.10, 95%CI=1.03 to 1.17, P<0.01), significantly increased the drop amplitude of ST-segment (SMD=0.44, 95%CI=0.17 to 0.70, P=0.001) and (SMD=1.85, 95%CI=1.53 to 2.17, P<0.01), significantly increased the drop rate of ST-segment (RR=1.51, 95%CI=1.20 to 1.89, P<0.01) and (RR=1.20, 95%CI=1.05 to 1.39, P=0.01); compared with the intraoperative application groups, the pre-operative application groups significantly increased level of the left ventricular ejection fraction (LVEF%) (SMD=0.46, 95%CI=0.13 to 0.79, P=0.007) and decreased the incidence of major adverse cardiovascular events (MACE) (RR=0.53, 95%CI=0.39 to 0.73, P<0.01), but there were no significant difference in LVEF% and MACE between preoperative application groups and post-operative application groups. There were no significant difference in the incidence of bleeding and complications between the pre-operative application group and intra-operative application group and post-operative application group. Conclusion Compared with tirofiban using during and after PCI, using before PCI can significantly improve microcirculation disturbance,increase myocardial tissue effective reperfusion,and reduce myocardial infarct size in STEMI patients.

R972

海南省醫(yī)藥衛(wèi)生科研項目（1901320714A2001）