右美托咪定对心脏外科手术相关急性肾损伤的影响：随机对照试验的荟萃分析及试验序贯分析。
Effect of Dexmedetomidine on Cardiac Surgery-Associated Acute Kidney Injury: A Meta-Analysis With Trial Sequential Analysis of Randomized Controlled Trials.
机构信息
Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA.
Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA.
出版信息
J Cardiothorac Vasc Anesth. 2020 Mar;34(3):603-613. doi: 10.1053/j.jvca.2019.09.011. Epub 2019 Sep 16.
OBJECTIVE
Cardiac surgery-associated acute kidney injury (CS-AKI) is associated with high mortality rates. This study aimed to determine the effects of perioperative dexmedetomidine (DEX) administration on CS-AKI in adult patients.
DESIGN
A meta-analysis with trial sequential analysis of randomized controlled trials.
SETTING
PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases were searched up to March 11, 2019 for relevant articles. The study protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42019128139).
PARTICIPANTS
Adult patients undergoing cardiac surgery.
INTERVENTIONS
Dexmedetomidine compared with controls.
MEASUREMENTS AND MAIN RESULTS
Nine randomized controlled trials with a total of 1,308 patients were included. Use of DEX significantly reduced the incidence of CS-AKI (risk ratio = 0.60, 95% confidence interval = 0.41-0.87, p = 0.008, I = 30%), without significant publication bias. The trial sequential analysis result suggested that there was enough evidence for this outcome. Sensitivity analysis confirmed the robustness of the result. The improvement of CS-AKI was primarily significant in preoperative and/or intraoperative administration of DEX with or without postoperative continuation, patients with age ≥60 years, and studies with low risk of bias. The subgroup analysis did not show statistical differences. Dexmedetomidine use also was associated with less prolonged ventilation and lower incidences of pulmonary complications and delirium postoperatively. The level of evidence was high for the incidence of CS-AKI on the Grading of Recommendations Assessment, Development and Evaluation profile.
CONCLUSION
Perioperative DEX administration provided protective effects against CS-AKI, especially when initiated before and during surgery in elderly patients.
目的
心脏手术相关急性肾损伤（CS-AKI）与高死亡率相关。本研究旨在确定围手术期右美托咪定（DEX）给药对成年心脏手术患者 CS-AKI 的影响。
设计
对随机对照试验进行荟萃分析和试验序贯分析。
设置
截至 2019 年 3 月 11 日，在 PubMed、EMBASE、Cochrane 图书馆和中国国家知识基础设施数据库中检索相关文章。研究方案在国际前瞻性系统评价注册库（注册号：CRD42019128139）中进行了注册。
参与者
接受心脏手术的成年患者。
干预措施
DEX 与对照组比较。
测量和主要结果
纳入了 9 项随机对照试验，共 1308 名患者。使用 DEX 可显著降低 CS-AKI 的发生率（风险比=0.60，95%置信区间=0.41-0.87，p=0.008，I=30%），且无显著发表偏倚。试验序贯分析结果表明，该结果有足够的证据支持。敏感性分析证实了结果的稳健性。CS-AKI 的改善主要在术前和/或术中给予 DEX 且术后继续给予或不继续给予、年龄≥60 岁的患者以及偏倚风险低的研究中具有显著意义。亚组分析未显示出统计学差异。DEX 还可减少术后机械通气时间延长和肺部并发症及谵妄的发生率。CS-AKI 的发生率在 Grading of Recommendations Assessment，Development and Evaluation 标准中属于高证据水平。
结论
围手术期 DEX 给药对 CS-AKI 具有保护作用，尤其是在老年患者手术前和手术期间开始使用时。
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