碳酸氢钠预防心脏手术相关急性肾损伤：一项系统评价和荟萃分析。

Sodium bicarbonate in the prevention of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis.

作者信息

Tie Hong-Tao, Luo Ming-Zhu, Luo Ming-Jing, Zhang Min, Wu Qing-Chen, Wan Jing-Yuan

出版信息

Crit Care. 2014 Sep 12;18(5):517. doi: 10.1186/s13054-014-0517-x.

DOI:10.1186/s13054-014-0517-x

PMID:25212718

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4177432/

Abstract

INTRODUCTION

Sodium bicarbonate (SBIC) was reported to be a promising approach to prevent cardiac surgery-associated acute kidney injury (CSA-AKI). However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of SBIC on the prevention of CSA-AKI in adult patients undergoing cardiac surgery.

METHODS

PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of SBIC versus placebo on the prevention of CSA-AKI in adult patients undergoing cardiac surgery were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of CSA-AKI. Meta-analysis was performed using random-effects models.

RESULTS

Five RCTs involving 1079 patients were included in the meta-analysis. Overall, compared with placebo, SBIC was not associated with a reduced risk of CSA-AKI (relative risk [RR] 0.99; 95% confidence interval [CI] 0.78 to 1.24; P = 0.911). SBIC failed to alter the clinical outcomes of hospital length of stay (weighted mean difference [WMD] 0.23 days; 95%CI -0.88 to 1.33 days; P = 0.688), renal replacement therapy (RR 0.94; 95%CI 0.49 to 1.82; P = 0.861), hospital mortality (RR 1.37; 95%CI 0.46 to 4.13; P = 0.572), postoperative atrial fibrillation (RR 1.02; 95%CI 0.65 to 1.61; P = 0.915). However, SBIC was associated with significant increased risks in longer duration of ventilation (WMD 0.64 hours; 95%CI 0.16 to 1.11 hours; P = 0.008), longer ICU length of stay (WMD 2.06 days; 95%CI 0.54 to 3.58 days; P = 0.008), and increased incidence of alkalemia (RR 2.21; 95%CI 1.42 to 3.42; P <0.001).

CONCLUSIONS

SBIC could not reduce the incidence of CSA-AKI. Contrarily, SBIC prolongs the duration of ventilation and ICU length of stay, and increases the risk of alkalemia. Thus, SBIC should not be recommended for the prevention of CSA-AKI and perioperative SBIC infusion should be administrated with caution.

摘要

引言

据报道，碳酸氢钠（SBIC）是预防心脏手术相关急性肾损伤（CSA-AKI）的一种有前景的方法。然而，结果仍存在争议。我们进行了一项系统评价和荟萃分析，以评估SBIC在预防接受心脏手术的成年患者CSA-AKI方面的疗效和安全性。

方法

系统检索了PubMed、EMbase、Web of science、EBSCO和Cochrane图书馆数据库。纳入评估SBIC与安慰剂对接受心脏手术的成年患者预防CSA-AKI效果的随机对照试验（RCT）。两名研究者独立检索文章、提取数据并评估纳入研究的质量。主要结局是CSA-AKI的发生率。使用随机效应模型进行荟萃分析。

结果

荟萃分析纳入了5项涉及1079例患者的RCT。总体而言，与安慰剂相比，SBIC与降低CSA-AKI风险无关（相对风险[RR]0.99；95%置信区间[CI]0.78至1.24；P = 0.911）。SBIC未能改变住院时间的临床结局（加权平均差[WMD]0.23天；95%CI -0.88至1.33天；P = 0.688）、肾脏替代治疗（RR 0.94；95%CI 0.49至1.82；P = 0.861）、医院死亡率（RR 1.37；95%CI 0.46至4.13；P = 0.572）、术后房颤（RR 1.02；95%CI 0.65至1.61；P = 0.915）。然而，SBIC与通气时间延长（WMD 0.64小时；95%CI 0.16至1.11小时；P = 0.008）、ICU住院时间延长（WMD 2.06天；95%CI 0.54至3.58天；P = 0.008）以及碱血症发生率增加（RR 2.21；95%CI 1.42至3.42；P <0.001）的风险显著增加相关。