Department of Cardiovascular Sciences, National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK.
Department of Cardiovascular Sciences, National Institute for Health Research Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK.
Br J Anaesth. 2021 Jan;126(1):131-138. doi: 10.1016/j.bja.2020.06.064. Epub 2020 Aug 20.
The aim of this systematic review was to summarise the results of randomised controlled trials (RCTs) that have evaluated pharmacological interventions for renoprotection in people undergoing surgery.
Searches were conducted to update a previous review using the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to August 23, 2019. RCTs evaluating the use of pharmacological interventions for renal protection in the perioperative period were included. The co-primary outcome measures were 30-day mortality and acute kidney injury (AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95% confidence intervals).
We included 228 trials enrolling 56 047 patients. Twenty-three trials were considered to be at low risk of bias across all domains. Atrial natriuretic peptides (14 trials; n=2207) reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43 [0.33, 0.56]) without heterogeneity. These effects were consistent across cardiac surgery and vascular surgery subgroups, and in sensitivity analyses restricted to studies at low risk of bias. Inodilators (13 trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events (RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36, 0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel blockers reduced AKI in primary analyses, but not after exclusion of studies at risk of bias. Overall, assessment of the certainty of the effect estimates was low.
There are multiple effective pharmacological renoprotective interventions for people undergoing surgery.
本系统综述的目的是总结评价手术患者应用药物干预进行肾脏保护的随机对照试验（RCT）的结果。
检索 Cochrane 对照试验中心注册库、MEDLINE 和 EMBASE 数据库，更新 2019 年 8 月 23 日前的相关研究。纳入评估围手术期应用药物干预进行肾脏保护的 RCT。主要的联合结局指标为 30 天死亡率和急性肾损伤（AKI）。汇总效应估计值以风险比（RR）（95%置信区间）表示。
共纳入 228 项试验，共计 56047 例患者。23 项研究在所有领域被认为存在低偏倚风险。心房利钠肽（14 项试验；n=2207）降低 30 天死亡率（RR：0.63 [0.41，0.97]）和 AKI 事件（RR：0.43 [0.33，0.56]），无异质性。这些效应在心脏手术和血管手术亚组以及低偏倚风险研究的敏感性分析中均一致。正性肌力药和扩血管药（13 项试验；n=2941）降低死亡率（RR：0.71 [0.53，0.94]）和 AKI 事件（RR：0.65 [0.50，0.85]），在主要分析中以及心脏手术队列中。血管加压素（4 项试验；n=1047）降低 AKI（RR：0.56 [0.36，0.86]）。一氧化氮供体、α-2 激动剂和钙通道阻滞剂在主要分析中降低 AKI，但在排除偏倚风险研究后无此作用。总体而言，评估效应估计值的确定性为低。
有多种有效的药物肾脏保护干预措施可用于手术患者。
