目的：血管内超声（IVUS）引导植入支架的效果目前仍存在争议，该研究旨在探讨血管内超声以及传统造影(Angiogra-phy)引导下支架植入效果在临床上的优劣比较。方法全面检索2000年1月—2014年6月国内外研究文献，筛选出符合评价标准的文献，采用RevMan5.0软件进行分析。以支架植入术后死亡、心肌梗死、靶血管血运重建、支架内血栓形成以及主要心血管不良事件为主要临床终点，分析血管内超声与血管造影植入支架效果之间的差异。结果血管内超声引导下支架植入术后心肌梗死（RR=0.67,95%CI：0.56~0.81；Z=4.08, P<0.0001）、靶血管血运重建（RR=0.76,95%CI：0.66~0.87； Z=3.87, P=0.0001）、支架内血栓形成（RR=0.62,95%CI：0.47~0.82； Z=3.35,P=0.0008）以及主要不良事件（RR=0.82,95%CI：0.73~0.91； Z=3.62, P=0.0003）的发生率均低于传统造影下支架植入术，差别有统计学意义。结论说明血管内超声支架植入术能显著降低术后心梗、靶血管血运重建、支架内血栓及主要不良时间的发生，相比传统冠脉造影更能让患者获益。%Otjective The outcomes of IVUS-guided stent implantation remain controversial. This is a systematic review to evalu-ate clinical benefits of IVUS-Guided stent implantation compared with conventional angiography. Methods The study was per-formed in Pubmed, Embase, Cochrane and Web of Knowledge database. We use death, myocardial infarction (MI), stent thrombosis (ST),and target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) as main outcomes to analyze the difference between IVUS-guided and angiography-guided stent implantations. Results There is a significant reduction in MI (RR=0.67, 95%CI:0.56~0.81;Z=4.08, P<0.0001),TVR(RR=0.76, 95%CI:0.66~0.87;Z=3.87, P=0.0001),ST(RR=0.62, 95%CI: 0.47~0.82; Z=3.35, P=0.0008)and MACE (RR=0.82, 95%CI:0.73 ~0.91; Z=3.62, P=0.0003) in favor of IVUS versus conventional angiography. Conclusion This systematic review demonstrates that IVUS-Guided stent implantation can reduce the events of death, MI, TVR, ST and MACE after stent implantation. It will bring more clinical benefits compared with angiography guidance.
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