Ashworth Alan, Webb Stephen T
Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
Interact Cardiovasc Thorac Surg. 2010 Sep;11(3):303-8. doi: 10.1510/icvts.2010.232413. Epub 2010 Jun 22.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does prophylactic administration of N-acetylcysteine (NAC) prevent acute kidney injury (AKI) following cardiac surgery?' More than 60 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The administration of NAC prior intravenous radioactive contrast has been shown to reduce the incidence of contrast-induced nephropathy. There have been two recent meta-analyses and several randomised controlled trials (RCTs) and investigating the effectiveness of prophylactic administration of NAC in the prevention of AKI following cardiac surgery. The RCTs have investigated the use of NAC to prevent AKI in low-risk patients, high-risk patients and high-risk patients with pre-existing chronic kidney disease. The meta-analyses and RCTs demonstrated that the prophylactic administration of NAC did not reduced the incidence of AKI, postoperative complications, postoperative interventions, mortality or length of ICU stay. We conclude that prophylactic administration of NAC does not prevent AKI or reduce mortality following cardiac surgery.
根据结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是“预防性给予N-乙酰半胱氨酸（NAC）能否预防心脏手术后的急性肾损伤（AKI）？”通过报告的检索方式找到了60多篇论文，其中10篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期、国家、所研究的患者群体、研究类型、相关结局和结果都列成了表格。已证明在静脉注射放射性造影剂前给予NAC可降低造影剂肾病的发生率。最近有两项荟萃分析以及多项随机对照试验（RCT），研究预防性给予NAC预防心脏手术后AKI的有效性。这些RCT研究了NAC在低风险患者、高风险患者以及已有慢性肾病的高风险患者中预防AKI的使用情况。荟萃分析和RCT表明，预防性给予NAC并未降低AKI的发生率、术后并发症、术后干预、死亡率或重症监护病房住院时间。我们得出结论，预防性给予NAC不能预防心脏手术后的AKI或降低死亡率。
