The Medical School, University of Sheffield, Sheffield, UK.
Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK.
J Surg Res. 2021 May;261:261-273. doi: 10.1016/j.jss.2020.12.037. Epub 2021 Jan 15.
Remote ischemic preconditioning (RIPC) may mitigate physiological stress related to surgery. There is no clear consensus on conduct of RIPC studies, or whether it is effective. The aim of this study was to (i) assess delivery of RIPC, (ii) identify reported outcomes, (iii) measure effect on key clinical outcomes.
This review was registered on PROSPERO (CRD:42020180725). EMBASE and Medline databases were searched, and results screened by two reviewers. Full-texts were assessed for eligibility by two reviewers. Data extracted were methods of RIPC and outcomes reported. Meta-analysis of key clinical events was performed using a Mantel-Haenszel random effects model. The TIDieR framework was used to assess intervention reporting, and Cochrane risk of bias tool was used for all studies included.
Searches identified 25 studies; 25 were included in the narrative analysis and 18 in the meta-analysis. RIPC was frequently performed by occluding arm circulation (15/25), at 200 mmHg (9/25), with three cycles of 5 min ischemia and 5 min of reperfusion (16/25). No study fulfilled all 12 TIDieR items (mean score 7.68). Meta-analysis showed no benefit of RIPC on MI (OR 0.71 95% CI 0.48-1.04, I2 = 0%), mortality (OR 0.56, 95% CI 0.31-1.01, I2 = 0%), or acute kidney injury (OR 0.72 95% CI 0.48-1.08).
RIPC could be standardized as 200 mmHg pressure in 3 × 5 min on and off cycles. The signal of benefit should be explored in a larger well-designed randomized trial.
远程缺血预处理（RIPC）可能减轻与手术相关的生理应激。目前对于 RIPC 研究的实施或其是否有效尚未达成明确共识。本研究旨在：（i）评估 RIPC 的实施情况，（ii）确定报告的结果，（iii）测量对关键临床结局的影响。
本研究已在 PROSPERO（注册号：CRD42020180725）上进行了注册。通过对 EMBASE 和 Medline 数据库进行检索，并由两名评审员筛选结果。两名评审员评估全文的纳入标准。提取的资料包括 RIPC 方法和报告的结果。使用 Mantel-Haenszel 随机效应模型对关键临床事件进行了荟萃分析。使用 TIDieR 框架评估干预措施的报告，并用 Cochrane 偏倚风险工具评估所有纳入的研究。
检索共确定了 25 项研究；25 项研究进行了叙述性分析，18 项研究进行了荟萃分析。RIPC 常通过阻塞手臂循环（15/25）、200mmHg（9/25）、3 个 5 分钟缺血和 5 分钟再灌注周期（16/25）进行。没有一项研究完全符合 TIDieR 12 项条目（平均得分为 7.68）。荟萃分析显示 RIPC 对心肌梗死（MI）（OR 0.71，95%CI 0.48-1.04，I2=0%）、死亡率（OR 0.56，95%CI 0.31-1.01，I2=0%）或急性肾损伤（AKI）（OR 0.72，95%CI 0.48-1.08）没有获益。
RIPC 可以标准化为 200mmHg 压力、3 个 5 分钟的 ON-OFF 周期。应该在一项更大、设计良好的随机试验中进一步探索其获益信号。
