Chen Wei-Cheng, Lin Meng-Hsuan, Chen Chieh-Lung, Chen Ying-Chieh, Chen Chih-Yu, Lin Yu-Chao, Hung Chin-Chuan
Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Rd., North Dist., Taichung 404332, Taiwan.
J Clin Med. 2021 Mar 3;10(5):1032. doi: 10.3390/jcm10051032.
Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56-0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45-0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.
几种正性肌力药物已用于危重症患者，以改善心脏手术后的血流动力学和肾功能障碍；然而，对于接受心脏手术患者降低死亡率和增强肾脏保护的治疗策略仍存在争议。因此，我们进行了一项综合网络荟萃分析，以克服缺乏直接对比研究的不足。检索系统数据库至2020年12月31日，查找比较不同正性肌力药物对心脏手术后死亡率结局和肾脏保护作用的随机对照试验。共纳入29项试验，并进行了频率学派网络荟萃分析。还进行了不一致性分析、发表偏倚分析和亚组分析。与安慰剂相比，使用左西孟旦可显著降低死亡率风险（比值比（OR）：0.74；95%置信区间（CI）：0.56 - 0.97）和急性肾损伤风险（OR：0.61；95%CI：0.45 - 0.82），尤其是在收缩功能低下的患者中。基于P值评分，使用左西孟旦也是最佳治疗方法（90.1%），其次是安慰剂（64.5%）、米力农（49.6%）、多巴胺（49.5%）、多巴酚丁胺（29.1%）和非诺多泮（17.0%）。综合所有现有数据，左西孟旦是治疗接受心脏手术患者的安全肾脏保护选择，尤其是对于那些收缩功能低下的患者。
