Baker William L, Anglade Moise W, Baker Erica L, White Charles Michael, Kluger Jeffrey, Coleman Craig I
University of Connecticut School of Pharmacy, Storrs, CT, USA.
Eur J Cardiothorac Surg. 2009 Mar;35(3):521-7. doi: 10.1016/j.ejcts.2008.11.027. Epub 2009 Jan 14.
Post-cardiothoracic surgery (CTS) complications (e.g. myocardial injury, renal dysfunction, atrial fibrillation) may occur as a result of enhanced systemic inflammation, perhaps provoked by an oxidative stress response. N-acetylcysteine (NAC) is a free radical scavenger antioxidant agent that may attenuate this physiologic response and reduce post-CTS complications. Thus, a meta-analysis was performed to help characterize the potential beneficial effects of perioperative NAC administration in patients undergoing CTS. A systematic literature search in MEDLINE, EMBASE and the Cochrane Library was conducted through April 2008. A search strategy using medical subject headings and text keywords was performed. Results are reported as odds ratios or weighted mean differences with accompanying 95% confidence intervals (CIs). Studies were pooled using a fixed-effect model. The primary outcomes included atrial fibrillation (AF), myocardial infarction (MI), stroke, acute kidney injury (AKI), need for renal replacement therapy (RRT), mortality and total hospital length-of-stay (LOS). Upon meta-analysis of 13 trials (n=1338 subjects), the use of NAC appeared to statistically significantly lower the odds of developing post-CTS AF by 36% (95%CI 2-58%) (n=6 studies). This corresponded to an 8% (1-15%) pooled risk difference and a number-needed-to-treat of 13. NAC did not appear to significantly alter any of the other meta-analysis endpoints. The exclusion of the study utilizing only oral NAC therapy and the study with lower internal validity did not affect the overall conclusions of our meta-analysis. Currently, the most compelling data for using NAC in CTS patients is in post-CTS AF prevention. However, additional, larger randomized controlled trials evaluating this and other postoperative complication endpoints are needed.
心胸外科手术后（CTS）并发症（如心肌损伤、肾功能不全、房颤）可能是由于全身炎症增强所致，这可能是由氧化应激反应引发的。N-乙酰半胱氨酸（NAC）是一种自由基清除抗氧化剂，可能会减弱这种生理反应并减少CTS后并发症。因此，进行了一项荟萃分析，以帮助描述围手术期给予NAC对接受CTS患者的潜在有益作用。通过2008年4月在MEDLINE、EMBASE和Cochrane图书馆进行了系统的文献检索。使用医学主题词和文本关键词进行检索策略。结果以比值比或加权平均差及伴随的95%置信区间（CI）报告。研究采用固定效应模型进行汇总。主要结局包括房颤（AF）、心肌梗死（MI）、中风、急性肾损伤（AKI）、肾脏替代治疗（RRT）需求、死亡率和总住院时间（LOS）。对13项试验（n = 1338名受试者）进行荟萃分析后，使用NAC似乎在统计学上显著降低了CTS后发生AF的几率36%（95%CI 2 - 58%）（n = 6项研究）。这相当于汇总风险差为8%（1 - 15%），需治疗人数为13。NAC似乎并未显著改变任何其他荟萃分析终点。排除仅使用口服NAC治疗的研究和内部效度较低的研究并不影响我们荟萃分析的总体结论。目前，在CTS患者中使用NAC最有说服力的数据是在预防CTS后AF方面。然而，需要更多更大规模的随机对照试验来评估这一点以及其他术后并发症终点。
