Department of Anesthesiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
J Cardiothorac Vasc Anesth. 2011 Apr;25(2):268-75. doi: 10.1053/j.jvca.2010.04.022.
N-acetylcysteine (NAC) reduces proinflammatory cytokines, oxygen free-radical production, and ameliorates ischemia reperfusion injury; therefore, it may theoretically reduce postoperative complications in cardiac surgery. The aim of this study was to determine, through systematic review and meta-analysis of all relevant randomized trials, whether NAC reduces mortality, morbidity, or resource utilization in cardiac surgery.
Meta-analysis.
University hospitals.
A total of 1,407 patients from 15 randomized studies were included in the analysis.
None.
All randomized trials searched up to May 2009 comparing the use of NAC versus placebo during cardiac surgery in any language and reporting at least 1 predefined outcome were included. The random effect model was used to calculate odds ratios (ORs, 95% confidence intervals [CIs]) and weighted mean differences (WMD, 95% CI) for dichotomous and continuous variables, respectively. During cardiac surgery, the use of NAC did not significantly decrease acute renal failure requiring renal replacement therapy (OR = 1.05; 95% CI, 0.52-2.11; p = 0.90), new atrial fibrillation (OR = 0.67; 95% CI, 0.37-1.22; p = 0.19), or mortality (OR = 0.81; 95% CI, 0.39-1.68; p = 0.57). There were no differences in the incidence of incremental increase in serum creatinine concentration greater than 25% above baseline (OR = 0.86; 95% CI, 0.66-1.12; p = 0.26), acute myocardial infarction (OR = 0.69; 95% CI, 0.29-1.61, p =0.39), stroke (OR = 0.78; 95% CI, 0.30-2.03; p = 0.61), red blood cell transfusion requirement (OR = 0.77; 95% CI, 0.45-1.31; p = 0.33), re-exploration (OR = 1.33; 95% CI, 0.70-2.26; p = 0.29), or postoperative drainage (WMD = 33 mL; 95% CI,-125 to 191 mL; p = 0.69) between NAC and placebo.
Current evidence shows that the perioperative use of NAC has no proven benefit or risk on clinically important outcomes in patients undergoing cardiac surgery.
N-乙酰半胱氨酸（NAC）可减少促炎细胞因子、氧自由基的产生，并改善缺血再灌注损伤；因此，它理论上可以减少心脏手术的术后并发症。本研究的目的是通过对所有相关随机试验进行系统评价和荟萃分析，确定 NAC 是否可以降低心脏手术患者的死亡率、发病率或资源利用。
荟萃分析。
大学医院。
共有 1407 名来自 15 项随机研究的患者纳入了分析。
无。
直到 2009 年 5 月为止，我们搜索了所有语言的比较心脏手术中使用 NAC 与安慰剂的随机试验，并报告了至少 1 个预设结局。使用随机效应模型计算二分类变量的比值比（OR，95%置信区间[CI]）和连续变量的加权均数差值（WMD，95%CI）。在心脏手术期间，NAC 的使用并未显著降低需要肾脏替代治疗的急性肾功能衰竭（OR=1.05；95%CI，0.52-2.11；p=0.90）、新发心房颤动（OR=0.67；95%CI，0.37-1.22；p=0.19）或死亡率（OR=0.81；95%CI，0.39-1.68；p=0.57）。血清肌酐浓度较基线升高>25%的发生率（OR=0.86；95%CI，0.66-1.12；p=0.26）、急性心肌梗死（OR=0.69；95%CI，0.29-1.61，p=0.39）、中风（OR=0.78；95%CI，0.30-2.03；p=0.61）、红细胞输注需求（OR=0.77；95%CI，0.45-1.31；p=0.33）、再次探查（OR=1.33；95%CI，0.70-2.26；p=0.29）或术后引流（WMD=33 mL；95%CI，-125 至 191 mL；p=0.69）在 NAC 和安慰剂之间无差异。
目前的证据表明，在接受心脏手术的患者中，围手术期使用 NAC 对临床重要结局没有证明的益处或风险。
