Department of Anesthesiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China.
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China -
J Cardiovasc Surg (Torino). 2024 Jun;65(3):280-288. doi: 10.23736/S0021-9509.24.12827-3. Epub 2024 Feb 27.
The current study was designed to systemically investigate the impact of remote ischemic conditioning (RIC) on intra- and postoperative bleeding and transfusion in patients undergoing cardiac surgery.
We included all randomized controlled trials (RCTs) comparing RIC with control on intra- and postoperative blood loss and blood transfusion. The inclusion criteria were as follows: 1) adult patients undergoing cardiac surgery; 2) RCT; 3) perioperative administration of RIC compared to control; 4) outcomes of interest reported. Exclusion criteria included: 1) case reports, reviews, or abstracts; 2) animal or cell studies; 3) duplicate publications; 4) studies lacking information about outcomes of interest.
Databases search yielded 24 RCTs including 3530 patients, 1765 patients were allocated into RIC group and 1765 into control group. The current study suggested that RIC administration was associated with reduced postoperative blood loss (WMD=-57.89; 95% CI: -89.89 to -25.89; P=0.0004). RIC did not affect the volume of intraoperative blood loss (WMD=-4.02; 95% CI: -14.09 to 6.05; P=0.43), the volume of intra- and postoperative transfusion of red blood cell (RBC) (WMD=-15.66; 95% CI: -39.35 to 8.03; P=0.20), the re-exploration for bleeding (WMD=-0.01; 95% CI: -0.03 to 0.01; P=0.21).
The current study demonstrated that, RIC reduced post-operative blood loss in adult patients undergoing cardiac surgeries. It also indicated that, RIC reduced intra-operative RBC transfusion in adult patients undergoing coronary artery bypass grafting. However, RIC did not influence intra-operative bleeding, post-operative blood transfusion.
本研究旨在系统地研究远程缺血预处理（RIC）对心脏手术患者围术期出血和输血的影响。
我们纳入了所有比较 RIC 与对照组围术期失血和输血的随机对照试验（RCT）。纳入标准如下：1）成人心脏手术患者；2）RCT；3）围手术期给予 RIC 与对照组相比；4）报告了感兴趣的结局。排除标准包括：1）病例报告、综述或摘要；2）动物或细胞研究；3）重复发表；4）缺乏感兴趣结局信息的研究。
数据库检索得到 24 项 RCT，共纳入 3530 例患者，其中 1765 例患者分配至 RIC 组，1765 例患者分配至对照组。本研究表明，RIC 给药与术后出血量减少相关（WMD=-57.89；95%CI：-89.89 至-25.89；P=0.0004）。RIC 不影响术中出血量（WMD=-4.02；95%CI：-14.09 至 6.05；P=0.43）、术中及术后红细胞（RBC）输注量（WMD=-15.66；95%CI：-39.35 至 8.03；P=0.20）、因出血再次探查（WMD=-0.01；95%CI：-0.03 至 0.01；P=0.21）。
本研究表明，RIC 可减少心脏手术成人患者的术后出血。还表明，RIC 可减少成人冠状动脉旁路移植术患者的术中 RBC 输血。然而，RIC 对术中出血、术后输血没有影响。
