Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, 34736Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Perfusion. 2023 Apr;38(3):591-599. doi: 10.1177/02676591211073783. Epub 2022 Feb 6.
Acute kidney injury (AKI) is a common complication following cardiopulmonary bypass (CPB) which can affect morbidity and mortality. Goal-directed perfusion (GDP) intended to avoid the nadir oxygen delivery index below the critical value is associated with reduced postoperative AKI. However, current studies suggested that GDP can only decrease the incidence of AKI stage 1 but showed no effects on AKI stages 2-3 and mortality. The objective of the present meta-analysis is to deter the effects of GDP on postoperative AKI in any stage and mortality following cardiac surgery.
MEDLINE, Embase, and the Cochrane Library were searched to identify all clinical trials comparing GDP with control (standard care) during cardiopulmonary bypass conducting in adults undergoing cardiac surgery. The primary outcome was postoperative acute kidney injury. Secondary outcomes included postoperative mortality and length of ICU stay. Data synthesis was obtained by using risk ratio with 95% confidence interval by a random-effects model.
From 1094 potential studies, 3 trials enrolling 777 patients were included. Meta-analysis suggested the GDP strategy based on DOi reduced postoperative AKI compared with standard CPB management (RR = 0.52; 95% CI: 0.38-0.70; < .0001), especially in AKI stage I (RR = 0.47; 95% CI: 0.33-0.66; < .0001). But the GDP strategy did not reduce the incidence of severe AKI (stages 2-3) and postoperative mortality.
The GDP strategy based on DOi during CPB obviously reduces AKI stage 1 and thus reduces overall AKI incidence. But it shows no effects on severe AKI (stages 2-3) and mortality.
急性肾损伤（AKI）是体外循环（CPB）后常见的并发症，可影响发病率和死亡率。旨在避免氧输送指数降至临界值以下的目标导向灌注（GDP）与术后 AKI 减少相关。然而，目前的研究表明，GDP 只能降低 AKI 1 期的发生率，但对 AKI 2-3 期和死亡率没有影响。本荟萃分析的目的是确定 GDP 对任何阶段的术后 AKI 和心脏手术后死亡率的影响。
检索 MEDLINE、Embase 和 Cochrane 图书馆，以确定所有比较 GDP 与 CPB 期间成人心脏手术中标准护理（对照）的临床试验。主要结局是术后急性肾损伤。次要结局包括术后死亡率和 ICU 住院时间。采用随机效应模型，使用风险比和 95%置信区间进行数据综合。
从 1094 项潜在研究中，纳入了 3 项纳入 777 例患者的试验。荟萃分析表明，基于 DOi 的 GDP 策略与标准 CPB 管理相比，降低了术后 AKI（RR = 0.52；95%CI：0.38-0.70；<0.0001），尤其是 AKI 1 期（RR = 0.47；95%CI：0.33-0.66；<0.0001）。但 GDP 策略并未降低严重 AKI（2-3 期）和术后死亡率的发生率。
CPB 期间基于 DOi 的 GDP 策略明显降低 AKI 1 期，从而降低总体 AKI 发生率。但对严重 AKI（2-3 期）和死亡率无影响。
