目的:讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法:芬太尼-异丙酚为Ⅰ组,咪唑安定-异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果:Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义(Plt;0.01)。结论:镇静无痛苦胃镜检查中芬太尼-异丙酚联合用药更舒适。
Objective To systematically evaluate the effectiveness and safety of pulsed field ablation (PFA) and radiofrequency ablation (RFA) in the treatment of atrial fibrillation. Methods Computer searches were conducted on PubMed, EMbase, The Cochrane Library, The Web of Science, China Biomedical Literature Database, CNKI, Wanfang, and VIP databases, with a search period from the establishment of each database until April 2025. Two researchers conducted literature screening, data extraction, and quality evaluation of the included studies based on predetermined inclusion and exclusion criteria. Standardized electronic forms were used for data extraction, with a focus on the balanced dataset after propensity score matching (PSM). Quality evaluation was conducted using the improved Newcastle Ottawa scale (NOS). Meta analysis was conducted using RevMan 5.4 and Stata 18.0 software, and subgroup analysis was performed based on the study type (whether PSM method was used or not). ResultsFinally, 14 studies were ultimately included, of which 6 studies applied the PSM method, with a total sample size of 3 172 cases (PFA group: 1 582 cases; RFA group: 1 590 cases. NOS score≥5 points. The meta-analysis results showed that the PFA group had a lower recurrence rate of atrial fibrillation [OR=0.75, 95%CI (0.63, 0.90), P=0.002], surgical complications [OR=0.63, 95%CI (0.41, 0.98), P=0.04], and surgical time [WMD=–37.32, 95%CI (–45.85, –28.78), P<0.001] compared to the RFA group, and the differences were statistically significant. In addition, compared to the PFA group, the RFA group had a shorter X-ray exposure time [WMD=7.65, 95%CI (4.41, 10.88), P<0.001], and the difference was statistically significant. There was no statistically significant difference between the two groups in terms of re ablation rate [OR=1.17, 95%CI (0.59, 2.31), P=0.65] and acute surgical success rate [OR=0.86, 95%CI (0.22, 3.35), P=0.82]. ConclusionCompared with RFA, PFA treatment for atrial fibrillation can reduce the recurrence rate, shorten the surgical time, and reduce surgical complications, indicating its good effectiveness and safety in the treatment of atrial fibrillation.
ObjectiveTo investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. ResultsTwenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoracotomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI 0.03-0.09). Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.