Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1152-1159. doi: 10.1053/j.jvca.2023.02.045. Epub 2023 Mar 4.
To compare the outcomes of patients receiving del Nido solution versus any other type of cardioplegia.
A systematic review and meta-analysis of randomized trials.
Cardiac operating rooms.
Adult patients (≥18 years old) undergoing cardiac surgery.
The EMBASE, MEDLINE, and CENTRAL databases were searched systematically from their inception until August 2022 for randomized controlled trials comparing del Nido versus other cardioplegias.
Ten studies were included, including 1,812 patients (871 in the del Nido group and 941 in the control group), and published after 2017. There were significant reductions in postoperative stroke and/or transient ischemic attack rate in the del Nido group: 9/467 (1.9%) v 25/540 (4.6%); odds ratio (OR), 0.43; 95% CI, 0.20-0.92 (p = 0.007). Del Nido cardioplegia was also associated with significantly shorter aortic cross-clamp time (mean difference, -8.99 minutes; 95% CI, -17.24 to -0.73 [p < 0.001]), significantly reduced need for defibrillation (89/582 [15%] v 252/655 [38%]; OR, 0.33; 95% CI, 0.15-0.72 [p < 0.001]), significantly lower risk of postoperative acute kidney injury (21/235 [8.9%] v 34/301 [11%]; OR, 0.50; 95% CI, 0.26-0.97 [p = 0.04]), with no effect on mortality (14/607 [2.3%] v 12/681 [1.8%]; p = 0.5).
According to the authors' meta-analysis of recent randomized clinical trials, del Nido is a safe cardioplegic solution, which might provide better organ protection in adult cardiac surgery without differences in mortality when compared to other cardioplegic solutions.
比较接受 del Nido 溶液与任何其他类型心脏停搏液的患者的结局。
系统评价和荟萃分析的随机试验。
心脏手术室。
接受心脏手术的成年患者（≥18 岁）。
从开始到 2022 年 8 月，系统地在 EMBASE、MEDLINE 和 CENTRAL 数据库中搜索比较 del Nido 与其他心脏停搏液的随机对照试验。
共纳入 10 项研究，包括 1812 例患者（del Nido 组 871 例，对照组 941 例），均发表于 2017 年后。del Nido 组的术后卒中和/或短暂性脑缺血发作发生率显著降低：9/467（1.9%）比 25/540（4.6%）；比值比（OR），0.43；95%置信区间（CI），0.20-0.92（p=0.007）。del Nido 心脏停搏液还与主动脉阻断时间明显缩短相关（平均差值，-8.99 分钟；95%CI，-17.24 至-0.73[ p<0.001]）、显著减少除颤需求（89/582 [15%]比 252/655 [38%]；OR，0.33；95%CI，0.15-0.72[ p<0.001]）、术后急性肾损伤风险显著降低（21/235 [8.9%]比 34/301 [11%]；OR，0.50；95%CI，0.26-0.97[ p=0.04]），但对死亡率无影响（14/607 [2.3%]比 12/681 [1.8%]；p=0.5）。
根据作者对最近随机临床试验的荟萃分析，del Nido 是一种安全的心脏停搏液，与其他心脏停搏液相比，在成人心脏手术中可能提供更好的器官保护，而死亡率无差异。
