Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2022 Dec 5;135(23):2798-2804. doi: 10.1097/CM9.0000000000002408.
Post-operative acute kidney injury (AKI) is one of the most common and serious complications after major surgery and is significantly associated with increased risks of morbidity and mortality. This meta-analysis was conducted to evaluate the effects of perioperative dexmedetomidine (Dex) administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.
The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched for studies comparing the effects of Dex vs. placebo on kidney function after non-cardiac surgery, and a pooled fixed-effect meta-analysis of the included studies was performed. The primary outcome was the occurence of post-operative AKI. The secondary outcomes included the occurence of intra-operative hypotension and bradycardia, intensive care unit (ICU) admission, duration of ICU stay, and hospital length of stay (LOS).
Six studies, including four randomized controlled trials (RCTs) and two observational studies, with a total of 2586 patients were selected. Compared with placebo, Dex administration could not reduce the odds of post-operative AKI (odds ratio [OR], 0.44; 95% confidence interval (CI), 0.18-1.06; P = 0.07; I2 = 0.00%, P = 0.72) in RCTs, but it showed a significant renoprotective effect (OR, 0.67; 95% CI, 0.48-0.95; P = 0.02; I2 = 0.00%, P = 0.36) in observational studies. Besides, Dex administration significantly increased the odds of intra-operative bradycardia and shortened the duration of ICU stay. However, there was no significant difference in the odds of intra-operative hypotension, ICU admission, and hospital LOS.
This meta-analysis suggests that perioperative Dex administration does not reduce the risk of AKI after non-cardiac surgery. However, the quality of evidence for this result is low due to imprecision and inconsistent types of non-cardiac operations. Thus, large and high-quality RCTs are needed to verify the real effects of perioperative Dex administration on the occurrence of AKI and the outcomes of recovery after non-cardiac surgery.
术后急性肾损伤（AKI）是大手术后最常见和最严重的并发症之一，与发病率和死亡率的增加显著相关。本荟萃分析旨在评估围手术期右美托咪定（Dex）给药对非心脏手术后 AKI 发生和恢复结果的影响。
系统检索 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库，以比较 Dex 与安慰剂对非心脏手术后肾功能的影响，并对纳入研究进行固定效应荟萃分析。主要结局是术后 AKI 的发生。次要结局包括术中低血压和心动过缓、重症监护病房（ICU）入住、ICU 入住时间和住院时间（LOS）。
共纳入 6 项研究，包括 4 项随机对照试验（RCT）和 2 项观察性研究，共 2586 例患者。与安慰剂相比，Dex 给药不能降低术后 AKI 的发生几率（比值比 [OR]，0.44；95%置信区间 [CI]，0.18-1.06；P = 0.07；I2 = 0.00%，P = 0.72），但在观察性研究中显示出显著的肾脏保护作用（OR，0.67；95%CI，0.48-0.95；P = 0.02；I2 = 0.00%，P = 0.36）。此外，Dex 给药显著增加了术中心动过缓的发生几率，并缩短了 ICU 入住时间。然而，术中低血压、ICU 入住和住院 LOS 的发生几率没有显著差异。
本荟萃分析表明，围手术期 Dex 给药不能降低非心脏手术后 AKI 的风险。然而，由于不精确和不一致的非心脏手术类型，该结果的证据质量较低。因此，需要进行大型和高质量的 RCT 来验证围手术期 Dex 给药对非心脏手术后 AKI 发生和恢复结果的真实影响。
