Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Cardiology Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China.
J Am Heart Assoc. 2020 Oct 20;9(19):e017939. doi: 10.1161/JAHA.120.017939. Epub 2020 Sep 29.
Background Moderate hypothermic circulatory arrest (MHCA) has been widely used in aortic arch surgery. However, the renal function after MHCA remains controversial. We performed a systematic review and meta-analysis direct comparison of the postoperative renal function of MHCA versus deep hypothermic circulatory arrest (DHCA) in aortic arch surgery. Methods and Results We searched PubMed, Embase, and the Cochrane Library for postoperative renal function after aortic arch surgery with using MHCA and DHCA, published from inception to January 31, 2020. The primary outcome was renal failure. Secondary outcomes were the need for renal therapy and other major postoperative outcomes. The random-effects model was used for all comparisons to pool the estimates. A total of 14 observational studies with 4142 patients were included. Compared with DHCA, MHCA significantly reduced the incidence of renal failure (odds ratio [OR], 0.76; 95% CI, 0.61-0.94; =0.011; I=0.0%) and the need of renal replacement (OR, 0.68; 95% CI, 0.48-0.97; =0.034; I=0.0%). Subgroup analysis showed that when the hypothermic circulatory arrest time was <30 minutes, the incidence of renal failure in MHCA group was significantly lower than that in DHCA group (OR, 0.73; 95% CI, 0.54-0.99; =0.040; I=1.1%), whereas an insignificant difference between 2 groups when hypothermic circulatory arrest time was >30 minutes (OR, 0.76; 95% CI, 0.51-1.13; =0.169; I=17.3%). Conclusions MHCA compared with DHCA reduces the incidence of renal failure and the need for renal replacement. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020169348.
背景 中度低温停循环（MHCA）已广泛应用于主动脉弓手术中。然而，MHCA 后肾功能的变化仍存在争议。我们进行了一项系统评价和荟萃分析，直接比较了 MHCA 与深低温停循环（DHCA）在主动脉弓手术中对术后肾功能的影响。
方法 我们检索了 PubMed、Embase 和 Cochrane 图书馆，以获取自成立至 2020 年 1 月 31 日期间使用 MHCA 和 DHCA 进行主动脉弓手术后肾功能的研究。主要结局为肾功能衰竭。次要结局为需要肾脏治疗和其他主要术后结局。所有比较均采用随机效应模型进行汇总估计。
结果 共纳入 14 项观察性研究，共 4142 例患者。与 DHCA 相比，MHCA 显著降低了肾功能衰竭的发生率（比值比 [OR]，0.76；95%可信区间 [CI]，0.61-0.94；=0.011；I=0.0%）和肾脏替代治疗的需要（OR，0.68；95% CI，0.48-0.97；=0.034；I=0.0%）。亚组分析显示，当低温循环阻断时间<30 分钟时，MHCA 组的肾功能衰竭发生率显著低于 DHCA 组（OR，0.73；95% CI，0.54-0.99；=0.040；I=1.1%），而当低温循环阻断时间>30 分钟时，两组间无显著差异（OR，0.76；95% CI，0.51-1.13；=0.169；I=17.3%）。
结论 MHCA 与 DHCA 相比，可降低肾功能衰竭和肾脏替代治疗的发生率。
