Huang Ya-Qun, Wen Rui-Ting, Li Xiao-Tong, Zhang Jiao, Yu Zhi-Ying, Feng Yu-Fei
Department of Pharmacy, Peking University People's Hospital, Beijing, China.
Department of Pharmaceutical Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
Front Pharmacol. 2021 Oct 12;12:747911. doi: 10.3389/fphar.2021.747911. eCollection 2021.
Hepatic inflow occlusion proceeded to reduce blood loss during hepatectomy induces ischemia-reperfusion (IR) injury in the remnant liver. Dexmedetomidine, a selective α-adrenoceptor agonist used as an anesthetic adjuvant, has been shown to attenuate IR injury in preclinical and clinical studies. However, a meta-analysis is needed to systematically evaluate the protective effect of perioperative dexmedetomidine use on IR injury induced by hepatectomy. A prospectively registered meta-analysis following Cochrane and PRISMA guidelines concerning perioperative dexmedetomidine use on IR injury after hepatectomy was performed searching Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Web of Science, CNKI, WanFang, and Sinomed for eligible randomized controlled trials up to 2021.3.31. The main outcome is postoperative liver function. Risk of bias was assessed by the Cochrane Risk of Bias tool. Review Manager 5.3 and Stata12.0 were applied to perform data analyses. Eight RCTs enrolling 468 participants were included. Compared with 0.9% sodium chloride, dexmedetomidine decreased serum concentration of ALT (WMD = -66.54, 95% CI: -92.10--40.98), AST (WMD= -82.96, 95% CI: -106.74--59.17), TBIL (WMD = -4.51, 95% CI: -7.32--1.71), MDA (WMD = -3.09, 95% CI: -5.17--1.01), TNF-α (WMD = -36.54, 95% CI: -61.33--11.95) and IL-6 (WMD = -165.05, 95% CI: -225.76--104.34), increased SOD activity (WMD = 24.70, 95% CI: 18.09-31.30) within postoperative one day. There was no significant difference in intraoperative or postoperative recovery parameters between groups. Perioperative administration of dexmedetomidine can exert a protective effect on liver IR injury after hepatectomy. Additional studies are needed to further evaluate postoperative recovery outcomes of dexmedetomidine with different dosing regimens.
肝血流阻断在肝切除术中可减少失血，但会导致残余肝发生缺血再灌注（IR）损伤。右美托咪定是一种用作麻醉辅助剂的选择性α-肾上腺素能受体激动剂，在临床前和临床研究中已显示可减轻IR损伤。然而，需要进行一项荟萃分析来系统评估围手术期使用右美托咪定对肝切除术所致IR损伤的保护作用。按照Cochrane和PRISMA指南，针对围手术期使用右美托咪定对肝切除术后IR损伤的情况进行了一项前瞻性注册荟萃分析，检索了Cochrane图书馆、PubMed、EMBASE、ClinicalTrials.gov、Web of Science、中国知网、万方和维普，以查找截至2021年3月31日符合条件的随机对照试验。主要结局指标为术后肝功能。采用Cochrane偏倚风险工具评估偏倚风险。应用Review Manager 5.3和Stata12.0进行数据分析。纳入了8项随机对照试验，共468名参与者。与0.9%氯化钠相比，右美托咪定可降低术后1天内血清谷丙转氨酶（ALT）浓度（加权均数差[WMD]=-66.54，95%可信区间[CI]：-92.10至-40.98）、谷草转氨酶（AST）浓度（WMD=-82.96，95%CI：-106.74至-59.17）、总胆红素（TBIL）浓度（WMD=-4.51，95%CI：-7.32至-1.71）、丙二醛（MDA）浓度（WMD=-3.09，95%CI：-5.17至-1.01）、肿瘤坏死因子-α（TNF-α）浓度（WMD=-36.54，95%CI：-61.33至-11.95）和白细胞介素-6（IL-6）浓度（WMD=-165.05，95%CI：-225.76至-104.34），并提高超氧化物歧化酶（SOD）活性（WMD=24.70，95%CI：18.09至31.30）。两组间术中或术后恢复参数无显著差异。围手术期给予右美托咪定可对肝切除术后的肝脏IR损伤发挥保护作用。需要进一步的研究来进一步评估不同给药方案的右美托咪定的术后恢复结局。
