Department of Anesthesiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Anesthesiology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama City, Kanagawa-Ken, 236-0004, Japan.
Sci Rep. 2023 Oct 18;13(1):17720. doi: 10.1038/s41598-023-44833-w.
Remote ischemic preconditioning (RIPC) protects organs from ischemia-reperfusion injury. Recent trials showed that RIPC improved gas exchange in patients undergoing lung or cardiac surgery. We performed a systematic search to identify randomized controlled trials involving RIPC in surgery under general anesthesia. The primary outcome was the PO/FO (P/F) ratio at 24 h after surgery. Secondary outcomes were A-a DO, the respiratory index, duration of postoperative mechanical ventilation (MV), incidence of acute respiratory distress syndrome (ARDS), and serum cytokine levels. The analyses included 71 trials comprising 7854 patients. Patients with RIPC showed higher P/F ratio than controls (mean difference [MD] 36.6, 95% confidence interval (CI) 12.8 to 60.4, I = 69%). The cause of heterogeneity was not identified by the subgroup analysis. Similarly, A-a DO (MD 15.2, 95% CI - 29.7 to - 0.6, I = 87%) and respiratory index (MD - 0.17, 95% CI - 0.34 to - 0.01, I = 94%) were lower in the RIPC group. Additionally, the RIPC group was weaned from MV earlier (MD - 0.9 h, 95% CI - 1.4 to - 0.4, I = 78%). Furthermore, the incidence of ARDS was lower in the RIPC group (relative risk 0.73, 95% CI 0.60 to 0.89, I = 0%). Serum TNFα was lower in the RIPC group (SMD - 0.6, 95%CI - 1.0 to - 0.3 I = 87%). No significant difference was observed in interleukin-6, 8 and 10. Our meta-analysis suggested that RIPC improved oxygenation after surgery under general anesthesia.Clinical trial number: This study protocol was registered in the University Hospital Medical Information Network (registration number: UMIN000030918), https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035305.
远程缺血预处理（RIPC）可保护器官免受缺血再灌注损伤。最近的试验表明，RIPC 可改善接受肺或心脏手术的患者的气体交换。我们进行了系统搜索，以确定涉及全身麻醉下手术的 RIPC 的随机对照试验。主要结局是术后 24 小时的 PO/FO（P/F）比值。次要结局是 A-a DO、呼吸指数、术后机械通气（MV）时间、急性呼吸窘迫综合征（ARDS）发生率和血清细胞因子水平。分析包括 71 项试验，共 7854 例患者。与对照组相比，接受 RIPC 的患者的 P/F 比值更高（平均差异 [MD] 36.6，95%置信区间 [CI] 12.8 至 60.4，I = 69%）。亚组分析未确定异质性的原因。同样，RIPC 组的 A-a DO（MD 15.2，95%CI -29.7 至 -0.6，I = 87%）和呼吸指数（MD -0.17，95%CI -0.34 至 -0.01，I = 94%）也较低。此外，RIPC 组更早脱机（MD -0.9 小时，95%CI -1.4 至 -0.4，I = 78%）。此外，RIPC 组的 ARDS 发生率较低（相对风险 0.73，95%CI 0.60 至 0.89，I = 0%）。RIPC 组的 TNFα 水平较低（SMD -0.6，95%CI -1.0 至 -0.3，I = 87%）。白细胞介素-6、8 和 10 无显著差异。我们的荟萃分析表明，RIPC 可改善全身麻醉下手术后的氧合。临床试验编号：本研究方案已在大学医院医疗信息网络（注册号：UMIN000030918）中注册，https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi？recptno=R000035305。
