目的 在直立倾斜试验的第二阶段药物激发试验中,临床上常用的药物有硝酸甘油或者异丙肾上腺素,舌下含服硝酸甘油(NTG)的直立倾斜试验,使用异丙肾上腺素(ISO)的直立倾斜试验,本文的研究目的就上述两种药物的应用效果进行比较。方法 应用电脑对常用的数据库进行文献检索,包括:EMbase、PubMed、Web of Science、Cochrane Library及四个中文数据库,搜集与硝酸甘油、异丙肾上腺素及直立倾斜试验有关的临床研究,检索时间范围均为建库至2023年6月9日,采用Rev Man 5.4软件来进行Meta分析。结果总共纳入了14个临床研究,共2506例有晕厥病史的患者作为研究对象。Meta分析结果示:NTG组与ISO组在诱发阳性反应上无显著差异[OR=1.1
95%CI(0.66
1.84)
P=0.7];NTG组与ISO组在出现阳性反应时间[MD=1.71
95%CI(1.19
2.24)
P<0.00001]、试验总时长[MD=-23.30
95%CI(-37.08
-9.52)
P=0.0009]、不良反应[OR=0.19
95%CI(0.10
0.37)
P<0.00001]比较,有统计学差异。结论 硝酸甘油与异丙肾上腺素在诱发阳性率上无统计学区别,但异丙肾上腺素整体试验耗费时间较长,给药方式复杂、且药物不良反应多见。
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