Yi Bin, Chen Xiang, Shi Han, Lin Tiao, Lin Haifeng, Xu Yi, Rong Jian
Department of Cardiothoracic Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Department of Extracorporeal Circulation, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Eur J Cardiothorac Surg. 2017 Apr 1;51(4):616-623. doi: 10.1093/ejcts/ezw372.
This article represents the first attempt to perform a pooled analysis about remote ischaemic preconditioning (RIPC) in reduction of acute kidney injury (AKI) of adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A systematic search was performed using PubMed (1966-5 January 2016), the Cochrane Library (1996-5 January 2016), the Web of Science (1986-5 January 2016) and Chinese database (SinoMed) (1978-5 January 2016) to identify studies that have described the effect of RIPC on AKI in adult patients undergoing cardiac surgery with CPB. The outcomes used for this analysis included the incidence of AKI and the need for renal replacement therapy (RRT). Thirteen randomized controlled trials (4370 participants) were included in this analysis. RIPC significantly reduced the risk of AKI (risk ratio, 0.81; 95% confidence interval, [0.66, 0.99]; P = 0.04; I2 = 46%) for adult patients compared with control group. However, there was no significant difference with respect to the incidence of RRT between the two groups. The present meta-analysis found that RIPC may reduce the incidence of AKI among adult patients following cardiac surgery with CPB. Adequately powered trials are warranted to provide further corroboration of our findings in the future.
本文首次尝试对远程缺血预处理（RIPC）降低接受体外循环（CPB）心脏手术的成年患者急性肾损伤（AKI）进行汇总分析。通过使用PubMed（1966年至2016年1月5日）、Cochrane图书馆（1996年至2016年1月5日）、科学网（1986年至2016年1月5日）和中国数据库（SinoMed）（1978年至2016年1月5日）进行系统检索，以识别描述RIPC对接受CPB心脏手术的成年患者AKI影响的研究。该分析使用的结果包括AKI的发生率和肾脏替代治疗（RRT）的需求。本分析纳入了13项随机对照试验（4370名参与者）。与对照组相比，RIPC显著降低了成年患者发生AKI的风险（风险比，0.81；95%置信区间，[0.66, 0.99]；P = 0.04；I2 = 46%）。然而，两组之间RRT的发生率没有显著差异。本荟萃分析发现，RIPC可能降低接受CPB心脏手术后成年患者AKI的发生率。有必要进行足够样本量的试验，以在未来进一步证实我们的研究结果。
