目的 系統(tǒng)性評(píng)價(jià)冠狀動(dòng)脈內(nèi)注射尼可地爾治療ST段抬高心肌梗死（STEMI）的臨床及預(yù)后效果。方法 計(jì)算機(jī)檢索中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）、萬(wàn)方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)（Wanfang Data）、維普期刊中文數(shù)據(jù)庫(kù)（VIP）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）、Web of Science、Wiley Online Library、Embase和PubMed數(shù)據(jù)庫(kù)，納入冠狀動(dòng)脈內(nèi)注射尼可地爾治療STEMI的隨機(jī)對(duì)照臨床試驗(yàn)研究（RCTs），檢索時(shí)間為建庫(kù)至2020年10月。采用Revman 5.3評(píng)價(jià)納入研究的方法學(xué)質(zhì)量，Stata 12.0軟件進(jìn)行Meta分析。結(jié)果 共納入12篇RCTs，934名患者。Meta分析結(jié)果顯示：試驗(yàn)組治療STEMI患者術(shù)后TIMI血流分級(jí)≤2發(fā)生率［OR=0.53，95% CI=（0.4，0.71）］、校正TIMI幀數(shù)［WMD=-8.93，95% CI=（-13.18，-4.67）］、左室射血分?jǐn)?shù)［SMD=0.65，95% CI=（0.42，0.88）］、左室舒張末期內(nèi)徑［WMD=-5.56，95% CI=（-7.75，-3.38）］、主要不良心血管事件［OR=0.54，95% CI=（0.4，0.72）］、再灌注心律失常［OR=0.55，95% CI=（0.33，0.91）］、心力衰竭發(fā)生情況［OR=0.4，95% CI=（0.19，0.86）］均顯著小于對(duì)照組（P<0.05）。結(jié)論 現(xiàn)有的臨床證據(jù)表明接受PCI的STEMI患者手術(shù)期間冠狀動(dòng)脈內(nèi)單獨(dú)注射尼可地爾能改善患者冠脈血流量，保留患者的心臟收縮功能，還可以降低主要不良心血管事件的發(fā)生率。

Objective To systematically evaluate the clinical and prognostic effects of intracoronary injection of nicorandil in the treatment of ST segment elevation myocardial infarction (STEMI). Methods Full-text Database of CNKI, Wanfang Data, VIP, CBM, Web of Science、Wiley Online Library、Embase and PubMed databases were searched by computer from the establishment of the database to October 2020. Revman 5.3 was used to evaluate the quality of the methodology included in the study, and Stata12.0 software was used for Meta-analysis. Results A total of 12 articles of RCTs and 934 patients were included. The results of Meta analysis showed that the incidence of TIMI flow grade ≤ 2 in patients with STEMI after treatment in the trial group[OR = 0.53, 95%CI = (0.4, 0.71)], corrected TIMI frames [WMD = -8.93, 95%CI = (-13.18, -4.67)], left ventricular ejection fraction [SMD = 0.65, 95%CI = (0.42, 0.88)], left ventricular end-diastolic dimension [WMD = -5.56, 95%CI = (-7.75, -3.38) ], the main adverse cardiovascular events [OR = 0.54, 95%CI = (0.4, 0.72) ], reperfusion arrhythmias [OR = 0.55, 95%CI = (0.33, 0.91) ], heart failure[OR = 0.4, 95%CI = (0.19, 0.86) ] were significantly lower than those in the control group (P < 0.05). Conclusion Existing clinical evidence shows that intracoronary injection of nicorandil alone during PCI can improve coronary blood flow, preserve cardiac systolic function, and reduce the incidence of major adverse cardiovascular events in STEMI patients.

R972

國(guó)家自然科學(xué)基金資助項(xiàng)目（81303243）；陜西秦嶺中草藥應(yīng)用開(kāi)發(fā)工程技術(shù)研究中心資助項(xiàng)目（2008ZDGC-32）