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1、双/单相波电击除颤治疗院前室颤的系统评价(作者:单位:邮编:)【摘要】目的系统评价双相波和单相波电击除颤治疗院前室颤的疗效。方法计算机检索配合手工检索，纳入院前发生室颤的患者采用双/单相波除颤器经胸壁电击除颤的随机对照试验(RCT)，并按照Cochrane协作网推荐的方法进行系统评价。结果共纳入RCT5篇，包括552例患者。Meta分析的结果显示双相截顶指数波较单相阻尼正弦波除颤器第一次除颤成功率［RR=1.09,95%CI(1.01,1.18),P=0.03］及除颤后有效心律恢复率［RR=0.53,95%
2、CI(0・32,0.87),P=0.01］更高，其余指标无统计学差异。结论根据现有的证据，可以认为双相波除颤对VF的终止率较高；但采用双相截顶指数波电击除颤与单相阻尼正弦波相比自主循环恢复率、出入院存活率并无差异。受原始文献质量和数量的影响，本系统评价Meta分析结果可能存在一定的偏倚，需要更多高质量的RCTs文献发表对结果进一步认定。【关键词】室颤除颤双相波单相波系统评价AbstractObjectiveToreviewsystematicallytheeffectofbiphasicandmonopha
3、sicdefibrillatorsintreatingpre-hospitalventricularfibrillation.MethodsComputerretrievalandmanualretrievalweremadetoRCTwithpre-hospitalventricularfibrillation,bybiphasicdefibrillatorastheinterventiongroupandbymonophasicdefibrillatorasthecontrolgroup,andCoch
4、ranesystematicreviewwasperformedwiththesoftwareRevMan4.2.9..Results552patientsfrom5RCTswereincluded,theMetaanalysisshowedthatthesuccessfulrateofthefirstdefibrillationandtherecoveryrateofeffectiveheartbeatafterdefibrillationinthepatientsbybiphasictoppingwav
5、edefibrillatorwerehigherthanthoseinthepatientsbymonophasicdampingsinewavedefibrillator(RR=1.09,95%CI(1.01,1.18),P=0.03);otherindexwereofnostatisticaldifference.ConclusionsWiththepresentsystematicreview,itcouldbeconeludedthatbiphasicdefibrillationhasahigher
6、terminationrateofventricularfibrillation;thereexistsnodifferenceintherecoveryrateofautonomiccirculationandthesurvivalratetohospitaladmissionandtohospitaldischargebetweenbiphasictoppingwavedefibrillatorandmonophasicdampingsinewavedefibrillator;theoutcomeoft
7、hissystematicreviewmayhascertainbiasbecauseofthequalityandquantityoftheoriginalliteratureandmorehigh-qualityRCTswillbehelpfulforfurtherconfirmationoftheoutcome.KEYWORDSventricularfibrillationdefibrillationbiphasicwavemonophasicwavesystematicreview室颤(Ventri
8、cularfibrillationVF)是一种严重心律失常,表现为快速、无规律、不协调的、缺乏有效心肌收缩和心脏泵血的室性节衛1］□在美国，由室颤引起的心脏骤停(SuddenCardiacArrestSCA)是院前最常见的死亡原因之一。对室颤引起的心脏骤停，电击除颤是最有效的治疗方法，可以挽救其生命，甚至恢复患者的窦性心律［2,3,4］现代除颤器根据除颤波形可分为两类：单相波除颤器和双相波除颤器。单相波除颤器从正
