From the Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Zhejiang, China.
Anesth Analg. 2018 Jul;127(1):30-38. doi: 10.1213/ANE.0000000000002674.
Remote ischemic preconditioning (RIPC) has been demonstrated to prevent organ dysfunction in cardiac surgery patients. However, recent large, prospective, multicenter, randomized controlled trials (RCTs) had controversial results. Thus, a meta-analysis of RCTs was performed to investigate whether RIPC can reduce the incidence of acute myocardial infarction (AMI), acute kidney injury (AKI), and mortality in adult cardiac surgery patients.
Study data were collected from Medline, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases. RCTs involving the effect of RIPC on organ protection in cardiac surgery patients, which reported the concentration or total release of creatine kinase-myocardial band, troponin I/troponin T (TNI/TNT) after operation, or the incidence of AMI, AKI, or mortality, were selected. Two reviewers independently extracted data using a standardized data extraction protocol where TNI or TNT concentrations; total TNI released after cardiac surgery; and the incidence of AKI, AMI, and mortality were recorded. Review Manager 5.3 software was used to analyze the data.
Thirty trials, including 7036 patients were included in the analyses. RIPC significantly decreased the concentration of TNI/TNT (standard mean difference [SMD], -0.25 ng/mL; 95% confidence interval [CI], -0.41 to -0.048 ng/mL; P = .004), creatine kinase-myocardial band (SMD, -0.22; 95% CI, -0.07-0.35 ng/mL; P = .46), and the total TNI/TNT release (SMD, -0.49 ng/mL; 95% CI, -0.93 to -0.55 ng/mL; P = .03) in cardiac surgery patients after a procedure. However, RIPC could not reduce the incidence of AMI (relative risk, 0.89; 95% CI, 0.70-1.13; P = .34) and AKI (relative risk, 0.88; 95% CI, 0.72-1.06; P = .18), and there was also no effect of RIPC on mortality in adult cardiac surgery patients. Interestingly, subgroup analysis showed that RIPC reduced incidence of AKI and mortality of cardiac surgery patients who received volatile agent anesthesia.
Our meta-analysis demonstrated that RIPC reduced TNI/TNT release after cardiac surgery. RIPC did not significantly reduce the incidence of AKI, AMI, and mortality. However, RIPC could reduce mortality in patients receiving volatile inhalational agent anesthesia.
远程缺血预处理（RIPC）已被证明可预防心脏手术患者的器官功能障碍。然而，最近的大型、前瞻性、多中心、随机对照试验（RCT）得出了有争议的结果。因此，进行了一项 RCT 的荟萃分析，以研究 RIPC 是否可以降低成人心脏手术患者急性心肌梗死（AMI）、急性肾损伤（AKI）和死亡率的发生率。
从 Medline、Elsevier、Cochrane 中央对照试验注册库和 Web of Science 数据库中收集研究数据。选择了涉及 RIPC 对心脏手术患者器官保护作用的 RCT，这些 RCT 报告了手术后肌酸激酶-心肌带或肌钙蛋白 I/肌钙蛋白 T（TNI/TNT）的浓度或总释放量，或 AMI、AKI 或死亡率的发生率。两位审查员使用标准化数据提取协议独立提取数据，其中记录了 TNI 或 TNT 浓度；手术后总 TNI 释放量；以及 AKI、AMI 和死亡率的发生率。使用 Review Manager 5.3 软件分析数据。
纳入了 30 项试验，共 7036 名患者。RIPC 显著降低了 TNI/TNT 的浓度（标准均数差 [SMD]，-0.25ng/ml；95%置信区间 [CI]，-0.41 至-0.048ng/ml；P=.004）、肌酸激酶-心肌带（SMD，-0.22；95%CI，-0.07 至 0.35ng/ml；P=.46）和手术后总 TNI/TNT 释放量（SMD，-0.49ng/ml；95%CI，-0.93 至-0.55ng/ml；P=.03）。然而，RIPC 不能降低 AMI（相对风险，0.89；95%CI，0.70-1.13；P=.34）和 AKI（相对风险，0.88；95%CI，0.72-1.06；P=.18）的发生率，并且 RIPC 对成人心脏手术患者的死亡率也没有影响。有趣的是，亚组分析表明，RIPC 降低了接受挥发性吸入麻醉剂麻醉的心脏手术患者 AKI 和死亡率的发生率。
我们的荟萃分析表明，RIPC 降低了心脏手术后 TNI/TNT 的释放。RIPC 并未显著降低 AKI、AMI 和死亡率的发生率。然而，RIPC 可以降低接受挥发性吸入麻醉剂麻醉的患者的死亡率。
