中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

左西孟旦在左心功能不全心脏病患者的围术期肾保护作用的系统评价与 Meta 分析

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目的 评估左西孟旦在左心功能不全心脏手术患者(术前 LVEF≤40.0%)中术后急性肾损伤(AKI)防治作用。 方法 检索 PubMed,EMBase 和 Cochrane Library 数据库中的随机对照试验(RCT)。检索时间为建库至 2018 年 1 月。临床研究终点包括 AKI,肾脏替代治疗(RRT),死亡率,机械通气(MV)时间,和重症监护室(ICU)停留时间。由于存在潜在的临床异质性所有分析采用随机效应模型。采用 RevMan 5.3 和 Stata 12.0 进行统计分析。 结果 本研究纳入 13 篇 RCTs 共计 2 046 例患者。与对照组相比,左西孟旦明显降低术后 AKI 发生率[比值比(OR)=0.44,P=0.000 1,I2=0.0%),RRT 使用率(OR=0.63, P=0.02,I2=0.0%)和死亡率(OR=0.49,P<0.000 1,I2=0.0%)。另外,左西孟旦也能改善 MV 时间(h)[加权均差(WMD)=–5.62,P=0.07,I2=93.0%]和 ICU 停留时间(d)(WMD=–1.5,P=0.005,I2=98.0%)。 结论 本研究的结果显示,在合并左心室功能不全(LVEF≤40%)患者的心脏手术中,左西孟旦能减少术后 AKI 发生,RRT 使用率,和死亡率,其也能减少术后机械通气和 ICU 停留时间。

Objective To evaluate the effect of levosimendan on acute kidney injury (AKI) in patients with left ventricular dysfunction (preoperative left ventricular ejection fraction≤40.0%) undergoing cardiac surgery. Methods A systematic review and meta-analysis was conducted based on the evidence of randomized controlled trials (RCT) from pubMed, EMBase, and Cochrane Library (up to Jan 2018). The clinical endpoints included the incidence of AKI and need for renal replacement therapy (RRT), mortality, mechanic ventilation(MV) duration, and intensive care unit (ICU) stay. Random-effect model was used for the potential clinical inconsistency. All analyses were performed in RevMan 5.3 and Stata 12.0. Results Thirteen trials with a total of 204 6 patients were selected. Compared with controls, levosimendan significantly reduced the incidence of postoperative AKI (OR=0.44, P=0.000 1, I2=0.0%), lowered the risk of RRT (OR=0.63, P=0.02, I2=0.0%) and decreased the mortality (OR=0.49, P<0.000 1,I2=0.0%). Levosimendan also reduced the postoperative MV duration (WMD=–5.62, P=0.07, I2=93.0%] and ICU stay (WMD=–1.5, P=0.005, I2=98.0%) Conclusion The present meta analysis suggests that perioperative levosimendan for patients with left ventricular ejection fraction ≤40.0% undergoing cardiac surgery reduces the incidence of AKI, RRT, death, MV duration and ICU stay.

关键词: 左西孟旦; 左心室功能不全; 心脏手术; 急性肾损伤; Meta 分析

Key words: Levosimendan; left ventricular dysfunction; cardiac surgery; acute kidney injury; meta-analysis

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