Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany -
Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Minerva Anestesiol. 2018 Nov;84(11):1298-1306. doi: 10.23736/S0375-9393.18.12465-5. Epub 2018 Jun 26.
So far, the concept of remote ischemic preconditioning (RIPC) failed its translation from experimental to clinical studies. In addition to our Cochrane Systematic Review, we systematically assessed the use of the intravenous anesthetic propofol, as a potential confounding factor.
We searched CENTRAL, MEDLINE, Embase and Web of Science. We included randomized controlled trials comparing RIPC with no RIPC in adult patients scheduled for coronary artery bypass graft surgery (with or without valve surgery) receiving either exclusively propofol or exclusively volatile anesthetics. Two authors independently assessed methodological quality and extracted data. We report odds ratios (ORs) with 95% confidence intervals as our summary statistics are based on random-effects models.
We included 14 studies involving 4060 participants. We found no difference in treatment effect between the propofol and volatile anesthetic groups when RIPC or no RIPC is applied on a composite endpoint (all-cause mortality, non-fatal myocardial infarction and/or any new stroke), all-cause mortality, non-fatal myocardial infarction, stroke, or length of stay on ICU. On cardiac markers, RIPC did show a treatment effect on cardiac troponin T measured as AUC 72 hours (SMD -0.80, CI -1.34, -0.25) in the propofol group. However, these findings have to be interpreted with great caution, to date only a very limited number of patients received volatile anesthetics in RIPC trials (minimum N.=15, maximum N.=232).
Present data do not permit a final assessment regarding the role of volatile or intravenous anesthetics as a possible confounding factor in RIPC trials.
到目前为止，远程缺血预处理（RIPC）的概念从实验研究到临床研究都未能成功转化。除了我们的 Cochrane 系统评价外，我们还系统评估了静脉麻醉药异丙酚的使用情况，将其作为一个潜在的混杂因素。
我们检索了 CENTRAL、MEDLINE、Embase 和 Web of Science。我们纳入了比较 RIPC 与非 RIPC 对接受纯异丙酚或纯挥发性麻醉剂的择期冠状动脉旁路移植术（伴或不伴瓣膜手术）成人患者的随机对照试验。两名作者独立评估方法学质量并提取数据。我们报告了比值比（OR）及其 95%置信区间，因为我们的汇总统计数据基于随机效应模型。
我们纳入了 14 项研究，涉及 4060 名参与者。当 RIPC 或无 RIPC 应用于复合终点（全因死亡率、非致死性心肌梗死和/或任何新发卒中）、全因死亡率、非致死性心肌梗死、卒中或 ICU 住院时间时，我们发现异丙酚组和挥发性麻醉剂组的治疗效果无差异。在心脏标志物方面，RIPC 确实显示了对心脏肌钙蛋白 T 的治疗效果，表现为 AUC 72 小时（SMD -0.80，CI -1.34，-0.25）。然而，这些发现必须谨慎解释，迄今为止，只有非常有限的患者在 RIPC 试验中接受了挥发性麻醉剂（最小 N.=15，最大 N.=232）。
目前的数据不允许对挥发性或静脉麻醉剂作为 RIPC 试验中可能的混杂因素的作用进行最终评估。
