Capital Medical University, Beijing Shijitan Hospital, Department of Intensive Care Unit, Beijing, China.
Capital Medical University, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Department of Pharmacy, Beijing, China.
Braz J Anesthesiol. 2024 May-Jun;74(3):744446. doi: 10.1016/j.bjane.2023.07.003. Epub 2023 Jul 14.
Acute Kidney Injury (AKI) is a common complication after cardiac surgery and has been associated with poor outcomes. Dexmedetomidine (DEX) has been shown to confer direct renoprotection based on some animal and clinical studies, but data from other trials came to the opposite conclusion following cardiac surgery. This meta-analysis was conducted to evaluate the effects of perioperative DEX administration on the occurrence of AKI and the outcomes after cardiac surgery.
We searched databases including EMBASE, PubMed, and Cochrane CENTRAL for Randomized Controlled Trials (RCTs) focused on DEX for AKI in adult patients after cardiac surgery. The primary outcome was incidence of AKI. Secondary outcomes were Mechanical Ventilation (MV) duration, Intensive Care Unit (ICU) Length Of Stay (LOS), hospital LOS and mortality.
Fifteen trials enrolling 2907 study patients were collected in the meta-analyses. Compared with controls, DEX reduced the incidence of postoperative AKI (Odds Ratio [OR = 0.66]; 95% Confidence Interval [95% CI 0.48-0.91]; p = 0.01), and there was no significant difference between groups in postoperative mortality (OR = 0.63; 95% CI 0.32-1.26; p = 0.19), MV duration (Weighted Mean Difference [WMD = -0.44]; 95% CI -1.50-0.63; p = 0.42), ICU LOS (WMD = -1.19; 95% CI -2.89-0.51; p = 0.17), and hospital LOS (WMD = -0.31; 95% CI -0.76-0.15; p = 0.19).
Perioperative DEX reduced the incidence of postoperative AKI in adult patients undergoing cardiac surgery. No significant decrease existed in mortality, MV duration, ICU LOS and hospital LOS owing to DEX administration.
急性肾损伤（AKI）是心脏手术后常见的并发症，并与不良结局相关。基于一些动物和临床研究，右美托咪定（DEX）已被证明具有直接的肾保护作用，但其他试验的数据得出了相反的结论。本荟萃分析旨在评估心脏手术后围手术期 DEX 给药对 AKI 发生和心脏手术后结局的影响。
我们检索了 EMBASE、PubMed 和 Cochrane CENTRAL 等数据库，以寻找针对心脏手术后成人患者 DEX 治疗 AKI 的随机对照试验（RCT）。主要结局是 AKI 的发生率。次要结局是机械通气（MV）持续时间、重症监护病房（ICU）住院时间（LOS）、住院 LOS 和死亡率。
共纳入了 15 项试验，涉及 2907 例研究患者。与对照组相比，DEX 降低了术后 AKI 的发生率（优势比 [OR] = 0.66；95%置信区间 [95%CI] 0.48-0.91；p = 0.01），但两组之间的术后死亡率无显著差异（OR = 0.63；95%CI 0.32-1.26；p = 0.19）、MV 持续时间（加权均数差 [WMD] = -0.44；95%CI -1.50-0.63；p = 0.42）、ICU LOS（WMD = -1.19；95%CI -2.89-0.51；p = 0.17）和住院 LOS（WMD = -0.31；95%CI -0.76-0.15；p = 0.19）。
围手术期 DEX 降低了心脏手术成人患者术后 AKI 的发生率。由于 DEX 给药，死亡率、MV 持续时间、ICU LOS 和住院 LOS 没有显著下降。
