脊髓刺激与其他疗法治疗难治性心绞痛患者的荟萃分析。

Spinal cord stimulation versus other therapies in patients with Refractory Angina: A meta-analysis.

作者信息

Wang Shaocheng, Li Qixian, Fang Hongwei, Yang Hao, Su Diansan, Tao Yuan-Xiang, Wang Zhankui, Wang Xiangrui, Yang Zhongwei

机构信息

Department of Anesthesiology, Bengbu Medical College, Anhui, Bengbu, China.

Department of Pain Management, South Compus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.

出版信息

Transl Perioper Pain Med. 2017;2(1):31-41.

PMID:28966934

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5619679/

Abstract

BACKGROUND

An increasing number of patients with coronary disease suffer from angina that cannot be controlled by optimal medical management and revascularization. The purpose of this study was to evaluate the method of spinal cord stimulation (SCS) for the treatment of patients with refractory angina (RA).

METHODS

We searched multiple databases, including PubMed, EMBASE, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. The results of studies through March 2016 were included in our analyses. Systematic methodological appraisal and data extraction were conducted by two independent reviewers. All data analyses utilized the Review Manager 5.3, and the results were merged as weighted mean differences (WMD).

RESULTS

Nine randomized controlled trials (RCTs) with a total of 364 patients who were diagnosed with RA were included in the analysis. After being pooled, the outcomes of the SCS treatment group did not differ from coronary artery bypass grafting (CABG) or percutaneous myocardial laser revascularization (PMR) treatment groups. However, compared with 'no SCS stimulation' treatment groups, SCS significantly decreased nitrate drug usage (WMD: -2.03, 95% CI: [-3.12, -0.93], p=0. 0003) and increased several indicators of health-related quality of life (HRQOL).

CONCLUSIONS

SCS appears to be a safe and effective management for RA although it has similar efficacy when compared to PMR or CABG as a potential replacement therapy. However, before this method is used as a conventional treatment, more high-quality designed multicenter RCTs are needed.

摘要

背景

越来越多的冠心病患者患有心绞痛，最佳药物治疗和血运重建无法控制这种症状。本研究的目的是评估脊髓刺激（SCS）治疗难治性心绞痛（RA）患者的方法。

方法

我们检索了多个数据库，包括PubMed、EMBASE、Cochrane图书馆和Cochrane对照试验中央注册库。纳入分析的是截至2016年3月的研究结果。由两名独立评审员进行系统的方法学评估和数据提取。所有数据分析均使用Review Manager 5.3，结果合并为加权平均差（WMD）。

结果

分析纳入了9项随机对照试验（RCT），共364例被诊断为RA的患者。汇总后，SCS治疗组的结果与冠状动脉旁路移植术（CABG）或经皮心肌激光血运重建术（PMR）治疗组无差异。然而，与“无SCS刺激”治疗组相比，SCS显著减少了硝酸酯类药物的使用（WMD：-2.03，95%CI：[-3.12，-0.93]，p = 0.0003），并提高了几个与健康相关生活质量（HRQOL）的指标。