目的 系统性评价冠状动脉内注射尼可地尔治疗ST段抬高心肌梗死（STEMI）的临床及预后效果。方法 计算机检索中国学术期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang Data）、维普期刊中文数据库（VIP）、中国生物医学文献数据库（CBM）、Web of Science、Wiley Online Library、Embase和PubMed数据库，纳入冠状动脉内注射尼可地尔治疗STEMI的随机对照临床试验研究（RCTs），检索时间为建库至2020年10月。采用Revman 5.3评价纳入研究的方法学质量，Stata 12.0软件进行Meta分析。结果 共纳入12篇RCTs，934名患者。Meta分析结果显示：试验组治疗STEMI患者术后TIMI血流分级≤2发生率［OR=0.53，95% CI=（0.4，0.71）］、校正TIMI帧数［WMD=-8.93，95% CI=（-13.18，-4.67）］、左室射血分数［SMD=0.65，95% CI=（0.42，0.88）］、左室舒张末期内径［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）］、心力衰竭发生情况［OR=0.4，95% CI=（0.19，0.86）］均显著小于对照组（P<0.05）。结论 现有的临床证据表明接受PCI的STEMI患者手术期间冠状动脉内单独注射尼可地尔能改善患者冠脉血流量，保留患者的心脏收缩功能，还可以降低主要不良心血管事件的发生率。

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

国家自然科学基金资助项目（81303243）；陕西秦岭中草药应用开发工程技术研究中心资助项目（2008ZDGC-32）