Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC.
J Cardiothorac Vasc Anesth. 2013 Dec;27(6):1224-32. doi: 10.1053/j.jvca.2013.03.027. Epub 2013 Sep 16.
Left ventricular systolic dysfunction is associated with increased morbidity and mortality in patients undergoing cardiac surgery. The authors performed a meta-analysis investigating the effects of levosimendan in cardiac surgery patients with and without preoperative systolic dysfunction.
Meta-analysis of randomized controlled trials.
Hospital.
The 1,155 patients who participated in 14 randomized controlled trials of perioperative levosimendan were included.
None.
PubMed, EMBASE, the Cochrane database of clinical trials, and conference proceedings were searched for clinical trials of perioperative levosimendan in patients undergoing cardiac surgery through May 1, 2012. Studies were grouped by mean ejection fraction (EF). Those with a mean EF <40% were designated as low-EF. Pooled results demonstrated a reduction in mortality with levosimendan (risk difference [RD]-4.2%; 95% CI -7.2%, -1.1%; p = 0.008). Subgroup analysis showed that this benefit was confined to the low-EF studies (RD -7.0%; 95% CI -11.0%, -3.1%; p < 0.001). No benefit was observed in the preserved-EF subgroup (RD +1.1%; 95% CI -3.8%, +5.9%; p = 0.66). Significant reductions also were seen in the need for dialysis (RD -4.9%; 95% CI -8.2%, -1.6%; p = 0.003), myocardial injury (RD -5.0%; 95% CI -8.3%, -1.7%; p = 0.003), and postoperative atrial fibrillation (RD -8.1%; 95% CI -13.3%, -3.0%; p = 0.002).
Levosimendan was associated with reduced mortality and other adverse outcomes in patients undergoing cardiac surgery, and these benefits were greatest in patients with reduced EF. These data support the need for adequately powered randomized clinical trials to confirm the benefits of levosimendan in patients with reduced EF undergoing cardiac surgery.
左心室收缩功能障碍与心脏手术患者的发病率和死亡率增加有关。作者进行了一项荟萃分析，研究了左西孟旦在术前收缩功能障碍和无术前收缩功能障碍的心脏手术患者中的作用。
随机对照试验的荟萃分析。
医院。
纳入了 14 项围手术期左西孟旦随机对照试验的 1155 名患者。
无。
通过 2012 年 5 月 1 日的 PubMed、EMBASE、Cochrane 临床试验数据库和会议记录，检索了围手术期左西孟旦在心脏手术患者中的临床试验。研究按平均射血分数（EF）分组。平均 EF <40% 的患者被指定为低 EF。汇总结果显示左西孟旦降低死亡率（风险差异[RD]-4.2%；95%CI-7.2%，-1.1%；p = 0.008）。亚组分析显示，这种益处仅限于低 EF 研究（RD-7.0%；95%CI-11.0%，-3.1%；p <0.001）。在保留 EF 亚组中未观察到益处（RD+1.1%；95%CI-3.8%，+5.9%；p = 0.66）。还观察到需要透析（RD-4.9%；95%CI-8.2%，-1.6%；p = 0.003）、心肌损伤（RD-5.0%；95%CI-8.3%，-1.7%；p = 0.003）和术后心房颤动（RD-8.1%；95%CI-13.3%，-3.0%；p = 0.002）的显著减少。
左西孟旦与心脏手术患者的死亡率和其他不良结局降低相关，并且在 EF 降低的患者中这些益处最大。这些数据支持需要进行充分的随机临床试验来证实左西孟旦在 EF 降低的心脏手术患者中的益处。
