Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei Province, China.
Shock. 2019 Sep;52(3):326-333. doi: 10.1097/SHK.0000000000001313.
To assess the benefits and harms of fenoldopam for nephroprotective effects in adult patients undergoing cardiac surgery.
We conducted a systematic review with meta-analysis of randomized controlled trials (RCTs) comparing fenoldopam with placebo in cardiac surgery. Trials were systematically searched from PubMed, EMBASE, CENTRAL, and CNKI databases, up to July 30, 2018. A trial sequential analysis (TSA) was used to determine whether the present evidence was valid and conclusive for the primary outcomes.
A total of seven randomized controlled trials involving 1,107 adult patients undergoing cardiac surgery fulfilled the inclusion criteria. The pooled analysis suggested that the use of fenoldopam was associated with a reduction in the incidence of AKI (18 of 216 [8.3%] in the fenoldopam group versus 45 of 222 [20.3%] in the placebo group, RR = 0.42 [0.26, 0.69], P = 0.0006) and with a higher rate of hypotension (92/357 [25.8%] versus 51/348 [14.7%], RR = 1.76 [1.29, 2.39], P = 0.0003). There was no significant effect on renal replacement therapy requirement (77 of 540 [14.3%] versus 75 of 536 [14.0%], P = 0.96) or hospital mortality (87/392 [22.2%] versus 83/383 [21.7%], P = 0.86). TSA supported the results of the conventional analysis on AKI.
Low-dose dopamine offers transient improvements in renal physiology, but no good evidence shows that it offers important clinical benefits to patients with or at risk for acute renal failure.Among patients treated with fenoldopam, there was a decrease in AKI and an increased incidence of hypotension, had no significant effect on RRT or mortality. Given that most studies were small and the definition of AKI was variable between studies, there is not enough evidence to support the systematic use of fenoldopam in cardiac surgery.
评估在接受心脏手术的成年患者中，使用非诺多泮的肾保护作用的益处和危害。
我们对心脏手术中使用非诺多泮与安慰剂进行比较的随机对照试验（RCT）进行了系统综述和荟萃分析。从 PubMed、EMBASE、CENTRAL 和 CNKI 数据库中系统地检索了试验，检索时间截至 2018 年 7 月 30 日。使用试验序贯分析（TSA）来确定主要结局的现有证据是否有效和具有结论性。
共有 7 项 RCT 符合纳入标准，共纳入 1107 名接受心脏手术的成年患者。汇总分析表明，使用非诺多泮可降低急性肾损伤（AKI）的发生率（非诺多泮组 18/216 [8.3%]，安慰剂组 45/222 [20.3%]，RR=0.42[0.26, 0.69]，P=0.0006），且低血压的发生率更高（非诺多泮组 92/357 [25.8%]，安慰剂组 51/348 [14.7%]，RR=1.76[1.29, 2.39]，P=0.0003）。但对肾替代治疗的需求（非诺多泮组 77/540 [14.3%]，安慰剂组 75/536 [14.0%]，P=0.96）或住院死亡率（非诺多泮组 87/392 [22.2%]，安慰剂组 83/383 [21.7%]，P=0.86）无显著影响。TSA 支持 AKI 常规分析的结果。
小剂量多巴胺可改善肾功能，但没有良好的证据表明其对急性肾衰竭患者或有急性肾衰竭风险的患者有重要的临床获益。在接受非诺多泮治疗的患者中，AKI 发生率降低，低血压发生率增加，但对 RRT 或死亡率无显著影响。由于大多数研究规模较小，且研究之间 AKI 的定义存在差异，因此尚无足够证据支持在心脏手术中系统使用非诺多泮。
