Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China.
Am J Kidney Dis. 2016 Mar;67(3):408-16. doi: 10.1053/j.ajkd.2015.09.015. Epub 2015 Oct 27.
Levosimendan has been shown to confer direct renoprotection in renal endotoxemic and ischemia-reperfusion injury and could increase renal blood flow in patients with low-cardiac-output heart failure. Results from clinical trials of levosimendan on acute kidney injury (AKI) following cardiac surgery are controversial.
A random-effect meta-analysis was conducted based on evidence from PubMed, EMBASE, and Cochrane Library.
SETTINGS & POPULATION: Adult patients undergoing cardiac surgery.
Randomized controlled trials comparing the renal effect of levosimendan versus placebo or other inotropic drugs during cardiac surgery.
Perioperative levosimendan continuous infusion at a rate of 0.1 to 0.2μg/kg/min following a loading dose (6-24μg/kg) for 24 hours or only 1 loading dose (24μg/kg) within 1 hour.
AKI, need for renal replacement therapy, mechanical ventilation duration, intensive care unit stay during hospitalization, and postoperative mortality (in-hospital or within 30 days).
13 trials with a total of 1,345 study patients were selected. Compared with controls, levosimendan reduced the incidence of postoperative AKI (40/460 vs 78/499; OR, 0.51; 95% CI, 0.34-0.76; P=0.001; I(2)=0.0%), renal replacement therapy (22/492 vs 49/491; OR, 0.43; 95% CI, 0.25-0.76; P=0.002; I(2)=0.0%), postoperative mortality (35/658 vs 94/657; OR, 0.41; 95% CI, 0.27-0.62; P<0.001; I(2)=0.0%), mechanical ventilation duration (in days; n=235; weighted mean difference, -0.34; 95% CI, -0.58 to -0.09; P=0.007], and intensive care unit stay (in days; n=500; weighted mean difference, -2.2; 95% CI, -4.21 to -0.13; P=0.04).
Different definitions for AKI among studies. Small sample size for some trials.
Perioperative administration of levosimendan in patients undergoing cardiac surgery may reduce complications. Future trials are needed to determine the dose effect of levosimendan in improving outcomes, especially in patients with decreased baseline kidney function.
研究表明，左西孟旦在肾内毒素血症和缺血再灌注损伤中具有直接的肾保护作用，并能增加低心输出量心力衰竭患者的肾血流量。心脏手术后左西孟旦治疗急性肾损伤（AKI）的临床试验结果存在争议。
基于 PubMed、EMBASE 和 Cochrane 图书馆的证据，进行了一项随机效应荟萃分析。
接受心脏手术的成年患者。
比较心脏手术期间左西孟旦与安慰剂或其他正性肌力药物对肾脏影响的随机对照试验。
在 24 小时内以 0.1 至 0.2μg/kg/min 的速度进行围手术期左西孟旦持续输注，随后给予负荷剂量（6-24μg/kg），或在 1 小时内仅给予 1 次负荷剂量（24μg/kg）。
AKI、需要肾脏替代治疗、机械通气时间、住院期间重症监护病房停留时间和术后死亡率（住院期间或 30 天内）。
共纳入 13 项试验，总计 1345 例研究患者。与对照组相比，左西孟旦降低了术后 AKI 的发生率（40/460 比 78/499；OR，0.51；95%CI，0.34-0.76；P=0.001；I(2)=0.0%）、肾脏替代治疗（22/492 比 49/491；OR，0.43；95%CI，0.25-0.76；P=0.002；I(2)=0.0%）、术后死亡率（35/658 比 94/657；OR，0.41；95%CI，0.27-0.62；P<0.001；I(2)=0.0%）、机械通气时间（天数；n=235；加权均数差，-0.34；95%CI，-0.58 至-0.09；P=0.007]和重症监护病房停留时间（天数；n=500；加权均数差，-2.2；95%CI，-4.21 至-0.13；P=0.04）。
研究中 AKI 的定义不同。一些试验的样本量较小。
心脏手术后围手术期给予左西孟旦可能会减少并发症。需要进一步的试验来确定左西孟旦改善结局的剂量效应，特别是在基线肾功能下降的患者中。
