He Guiyuan, Li Qi, Li Wenxin, Wang Li, Yang Jun, Zeng Fanju
Department of Respiratory Medicine, The First College of Clinical Medical Sciences, Yichang Central People's Hospital, China Three Gorges University, Yichang, Hubei province, China.
Institute of Evidence-Based and Translational Medicine, China Three Gorges University, Yichang, Hubei province, China.
Heart Surg Forum. 2018 Dec 19;21(6):E513-E521. doi: 10.1532/hsf.2193.
The aim of this study was to determine whether N-acetylcysteine (NAC) has an effect on acute kidney injury (AKI) in chronic kidney disease patients undergoing cardiac surgery.
We reviewed literature through PubMed, Medline through PubMed and OVID, The Cochrane Library, Wan Fang Database, China Biology Medicine Database, Chinese Periodical Database, China Knowledge Resource Integrated Database, and Chinese Clinical Trial Registry (1980 to July 10, 2018). Two investigators independently collected the data and assessed the quality of each study. RevMan 5.3 was used for the present metaanalysis.
A total of 5 RCTs (N = 678 participants) were included in the primary analysis. Pooled analysis showed that intravenous infusion of NAC significantly reduced the incidence of AKI (RR = 0.77, 95% = 0.63 to 0.94, P < .01) and that NAC could decrease the adverse cardiac events (RR = 0.83, 95% = 0.70 to 0.97, P < .05), but that it may increase the length of stay in the ICU (mean difference [MD] = 2.1, 95% CI = 1.61 to 2.60, P < .01). There were no statistically significant differences between the 2 groups in the requirement for renal replacement therapy(RRT) (RR = 1.33, 95% = 0.63 to 2.81, P = .45) and all-cause mortality (RR = 0.51, 95% = 0.25 to 1.06, P = .07).
Our study shows that intravenous infusion of NAC could prevent postoperative AKI in preexisting-renal-failure patients undergoing cardiac surgery.
本研究旨在确定N-乙酰半胱氨酸（NAC）对接受心脏手术的慢性肾病患者急性肾损伤（AKI）是否有影响。
我们通过PubMed、通过PubMed和OVID检索的Medline、Cochrane图书馆、万方数据库、中国生物医学数据库、中国期刊数据库、中国知识资源总库和中国临床试验注册中心（1980年至2018年7月10日）对文献进行了回顾。两名研究者独立收集数据并评估每项研究的质量。本荟萃分析使用RevMan 5.3。
初步分析共纳入5项随机对照试验（N = 678名参与者）。汇总分析显示，静脉输注NAC可显著降低AKI的发生率（RR = 0.77，95% = 0.63至0.94，P <.01），且NAC可降低不良心脏事件（RR = 0.83，95% = 0.70至0.97，P <.05），但可能会增加在重症监护病房的住院时间（平均差[MD] = 2.1，95%CI = 1.61至2.60，P <.01）。两组在肾脏替代治疗（RRT）需求（RR = 1.33，95% = 0.63至2.81，P =.45）和全因死亡率（RR = 0.51，95% = 0.25至1.06，P =.07）方面无统计学显著差异。
我们的研究表明，静脉输注NAC可预防接受心脏手术的已有肾衰竭患者术后发生AKI。
