Gandhi Ajay, Husain Mubassher, Salhiyyah Kareem, Raja Shahzad G
Homerton University Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):750-5. doi: 10.1093/icvts/ivs208. Epub 2012 Jul 3.
A best evidence topic was constructed according to a structured protocol. The question addressed was 'Does perioperative furosemide usage reduce the need for renal replacement therapy in cardiac surgery patients?' Forty-seven 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. Current best available evidence to resolve the issue includes a systematic review and nine randomized controlled trials (RCTs). The systematic review of seven RCTs and one observational study has demonstrated that in patients who have undergone cardiac surgery, a more consistent and sustained diuresis is produced by a continuous infusion of furosemide compared with intermittent bolus doses of furosemide. However, there does not appear to be a significant difference in the total urine output or a change in serum electrolyte levels when furosemide is administered as a continuous infusion compared with intermittent bolus doses. Three RCTs recruiting neonatal and paediatric patients after open heart surgery also validated the safety and efficacy of furosemide infusion as well as intermittent bolus doses. Two of the five RCTS in adult cardiac surgery patients showed that furosemide infusion was associated with a reduced need for renal replacement therapy (RRT), while two RCTs failed to show any benefit and one reported an increased incidence of renal impairment. We conclude that continuous furosemide infusion in the perioperative period promotes a gentle and sustained diuresis in cardiac surgery patients. The evidence supporting the benefit of this strategy in terms of reducing the need for RRT is weak. At the same time, current best available evidence, albeit from small RCTs, suggests that the timely introduction of continuous furosemide infusion does not increase the incidence of renal impairment after cardiac surgery.
根据结构化协议构建了一个最佳证据主题。所探讨的问题是“围手术期使用呋塞米是否能减少心脏手术患者对肾脏替代治疗的需求？”通过报告的检索找到了47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、出版日期和国家、所研究的患者群体、研究类型、相关结果和结果被制成表格。解决该问题的当前最佳现有证据包括一项系统评价和九项随机对照试验（RCT）。对七项RCT和一项观察性研究的系统评价表明，在接受心脏手术的患者中，与间歇性推注呋塞米相比，持续输注呋塞米能产生更持续、稳定的利尿作用。然而，与间歇性推注剂量相比，持续输注呋塞米时，总尿量或血清电解质水平变化似乎没有显著差异。三项纳入心脏直视手术后新生儿和儿科患者的RCT也证实了呋塞米输注以及间歇性推注剂量的安全性和有效性。在成年心脏手术患者的五项RCT中，有两项显示呋塞米输注与肾脏替代治疗（RRT）需求减少有关，而两项RCT未显示任何益处，一项报告肾功能损害发生率增加。我们得出结论，围手术期持续输注呋塞米可促进心脏手术患者温和、持续的利尿。支持该策略在减少RRT需求方面有益的证据薄弱。同时，当前最佳现有证据（尽管来自小型RCT）表明，及时引入持续呋塞米输注不会增加心脏手术后肾功能损害的发生率。
