Zheng LanLan, Han RuiLi, Tao Lei, Yu Qian, Li JiangJing, Gao ChangJun, Sun XuDe
Department of Anesthesiology, Tangdu Hospital, Air Force Military Medical University, 710038 Xian, Shanxi Province, China.
Department of Anesthesiology, Tangdu Hospital, Air Force Military Medical University, 710038 Xian, Shanxi Province, China.
J Clin Anesth. 2020 Aug;63:109795. doi: 10.1016/j.jclinane.2020.109795. Epub 2020 Mar 21.
A number of trials have shown that remote ischemic preconditioning (RIPC) could reduce lung injury of patients suffering cardiovascular surgery, pulmonary transplantation surgery and thoracic surgery with one-lung ventilation. However, there is still a controversy over the lung protection of RIPC in patients who suffers different types of surgery. We undertook meta-analysis of the randomized controlled trials to evaluate the effect of remote ischemic preconditioning on clinical outcomes of patients with lung injury.
Systematic review and meta-analysis.
Perioperative care areas.
Adults and infants suffering cardiovascular surgery with lung injury.
Remote ischemic preconditioning.
The literatures were selected complying with the inclusive and exclusive criteria from the following databases as PubMed, Embase, Medline, Chinese Biomedical Literature and Journal Databases, Chinese Academic and VIP journal full-text Databases. Inclusion criteria includes: (1) Human clinical randomized and controlled trial; (2) the article we included is a clinical randomized controlled study; (3) the article discusses the effect of RIPC on lung injury of patients; (4) the primary evaluation indicators of the inclusive studies included postoperative intensive care unit stay time and mechanical ventilation time; (5) published in the form of full text, any language; (6) the type of operation is cardiovascular surgery; (7) there is no serious COPD, ARDS, respiratory failure and other lung diseases. Articles were excluded if they reported none of the outcomes as follows: postoperative intensive care unit stay time and mechanical ventilation time, human clinical controlled trails, pulmonary protection of RIPC, prospective clinical controlled trials. Two independent reviewers screened abstracts and titles, and selected records following full-text review. Software RevMan5.3 and STATA 12.0 were adopted to perform Meta-analysis.
The search finally includes10 studies of 708 patients, 352 patients in RIPC group and 356 patients in control group. The baseline characteristics of patients are no differences in two groups (P > 0.05). Compared with control group, RIPC significantly reduced the duration of ICU (P < 0.05) and mechanical ventilation time (P < 0.05) in RIPC group. In addition, the serum TNF-α and MDA concentration 24 h after operation in RIPC group are significantly lower than control group (P < 0.05). However, there are no significant differences between RIPC group and control group in terms of serum IL-6, IL-8 concentrations, A-aDO, PaO/FiO and respiratory index 24 h after operation.
RIPC can decrease pulmonary inflammatory responses, reduce the duration of ICU and mechanical ventilation time, and improve the clinical outcomes of patients with lung injury.
多项试验表明，远程缺血预处理（RIPC）可减轻接受心血管手术、肺移植手术及单肺通气胸科手术患者的肺损伤。然而，RIPC对不同类型手术患者的肺保护作用仍存在争议。我们进行了随机对照试验的荟萃分析，以评估远程缺血预处理对肺损伤患者临床结局的影响。
系统评价与荟萃分析。
围手术期护理领域。
患有肺损伤的心血管手术成人及婴儿。
远程缺血预处理。
从PubMed、Embase、Medline、中国生物医学文献数据库和期刊数据库、中国学术期刊全文数据库和维普期刊全文数据库等数据库中按照纳入和排除标准选择文献。纳入标准包括：（1）人类临床随机对照试验；（2）纳入的文章为临床随机对照研究；（3）文章讨论RIPC对患者肺损伤的影响；（4）纳入研究的主要评价指标包括术后重症监护病房停留时间和机械通气时间；（5）以全文形式发表，不限语言；（6）手术类型为心血管手术；（7）无严重慢性阻塞性肺疾病、急性呼吸窘迫综合征、呼吸衰竭等肺部疾病。如果文章未报告以下任何结果，则予以排除：术后重症监护病房停留时间和机械通气时间、人类临床对照试验、RIPC的肺保护作用、前瞻性临床对照试验。两名独立评审员筛选摘要和标题，并在全文评审后选择记录。采用RevMan5.3和STATA 12.0软件进行荟萃分析。
最终检索到708例患者的10项研究，RIPC组352例，对照组356例。两组患者的基线特征无差异（P>0.05）。与对照组相比，RIPC组显著缩短了重症监护病房停留时间（P<0.05）和机械通气时间（P<0.05）。此外，RIPC组术后24小时血清肿瘤坏死因子-α和丙二醛浓度显著低于对照组（P<0.05）。然而，RIPC组与对照组术后24小时血清白细胞介素-6、白细胞介素-8浓度、肺泡动脉血氧分压差、动脉血氧分压/吸入氧分数和呼吸指数无显著差异。
RIPC可减轻肺部炎症反应，缩短重症监护病房停留时间和机械通气时间，改善肺损伤患者的临床结局。
