Objective To systematically review the effectiveness and safety of intracoronary glycoprotein IIb/IIIa inhibitors (GPIs) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) compared with intravenous administration. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 9, 2012), Ovid, CBM, CNKI and VIP were electronically searched for randomized controlled trials (RCTs) about intracoronary GPIs administration versus intravenous administration undergoing PCI for ACS from inception to September 30th, 2012. Meanwhile, domestic relevant papers published in recent 1 year were also retrieved manually. References of the included studies were retrieved, too. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodologically quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 10 RCTs involving 3 553 ACS patients were finally included. The results of meta-analysis showed that: compared with intravenous administration, intracoronary GPIs administration decreased the major adverse cardiovascular event (MACE) (OR=0.54, 95%CI 0.34 to 0.85, P=0.008). The incidences of re-infarction (MI), revascularization (TVR) and heart failure were (OR=0.62, 95%CI 0.39 to 0.97, P=0.04), (OR=0.59, 95%CI 0.36 to 0.97, P=0.04), (OR=0.52, 95%CI 0.32 to 0.84, P=0.008), respectively. But for the mortality, there were no significant differences between the two groups (OR=0.81, 95%CI 0.58 to 1.14, P=0.23). Intravenous administration and intracoronary administration were alike in the incidences of mild/serious bleeding (mild: OR=0.94, 95%CI 0.75 to 1.19, P=0.63; serious: OR=1.18, 95%CI 0.76, 1.84, P=0.47). Conclusion Compared with routine GPIs regimen of intravenous bolus, intracoronary administration with initial dosage showed significant benefits in clinical outcomes in ACS patients undergoing PCI, which could not increase the incidence of bleeding.
目的 通過Narcotrend指導丙泊酚的靶控濃度來研究帕瑞昔布鈉超前鎮痛對宮腔手術患者術中和術后鎮痛效果的影響。 方法 2012年1月－6月，60例實施宮腔手術的患者隨機分為A、B兩組，每組30例，A組為術前20 min靜脈注射帕瑞昔布鈉組，B組為術前20 min靜脈注射等量生理鹽水組。記錄Narcotrend值D1，患者心率穩定時兩組的靶控濃度、血壓、心率、血氧飽和度（SpO2）及患者術蘇醒后10 min鎮痛效果視覺模擬評分（VAS）、Riker鎮靜、躁動評分（SAS）。 結果 A組患者的瑞芬太尼目標靶控濃度小于B組（P＜0.05），兩組的丙泊酚靶控濃度差異無統計學意義（P＞0.05）。兩組患者血壓、心率均小于術前（P＜0.05），SpO2與術前比較差異無統計學意義（P＞0.05）。術后患者VAS評分A組低于B組（P＜0.05），SAS評分B組高于A組（P＜0.05）。 結論 帕瑞昔布鈉對Narcotrend值無影響，帕瑞昔布鈉能減少宮腔手術患者術中、術后的疼痛及術后的躁動。