Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials.
Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.3389/fcvm.2021.601470
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发表时间：
2021
影响因子：
3.6
通讯作者：
Liu X
中科院分区：
文献类型：
--
作者：
Liu Z;Zhao Y;Lei M;Zhao G;Li D;Sun R;Liu X
目的：评估远程缺血预处理（RIPC）对心脏手术后急性肾损伤（AKI）影响的随机对照试验（RCT）显示出不一致的结果。我们进行了荟萃分析来评估 RIPC 对心脏手术后 AKI 的疗效。方法：通过检索 PubMed、Embase 和 Cochrane's Library 数据库获得相关研究。使用随机效应模型来汇总结果。荟萃回归和亚组分析用于确定异质性的来源。结果：纳入了 22 项 RCT，涉及 5,389 名接受心脏手术的患者，其中 RIPC 组 2,702 名患者，对照组 2,687 名患者。检测到中等异质性（Cochrane Q 检验的 p = 0.03，I2 = 40%）。汇总结果显示，与对照相比，RIPC 显着降低了 AKI 的发生率 [比值比 (OR)：0.76，95% 置信区间 (CI)：0.61–0.94，p = 0.01]。仅限于体外循环手术（OR：0.78，95% CI：0.64-0.95，p = 0.01）或急性 RIPC 研究（OR：0.78，95% CI：0.63-0.97，p = 0.03）的结果显示一致的结果。荟萃回归和亚组分析表明，研究特征，包括研究设计、国家、年龄、性别、糖尿病状况、手术类型、异丙酚或挥发性麻醉剂的使用、交叉钳夹时间、RIPC 方案、AKI 的定义和样本量，对 AKI 的结果没有显着影响。分层分析结果显示，RIPC 显着降低了不需要肾脏替代治疗的轻中度 AKI 风险（RRT，OR：0.76，95% CI：0.60-0.96，p = 0.02），但没有显着降低心脏术后患者需要 RRT 的重度 AKI 风险（OR：0.73，95% CI：0.50-1.07，p = 0.11）。结论：目前的证据支持 RIPC 作为预防心脏手术后 AKI 的有效策略，这似乎主要是由于不需要 RRT 的轻至中度 AKI 事件减少所致。需要努力确定患者特征、手术、围手术期药物和 RIPC 方案对结果的影响。
Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery. Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity. Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11). Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.
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影响因子：
3.7
作者：
Meybohm P;Renner J;Broch O;Caliebe D;Albrecht M;Cremer J;Haake N;Scholz J;Zacharowski K;Bein B
通讯作者：
Bein B
影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
19.6
作者：
Gallagher, Sean M.;Jones, Dan A.;Yaqoob, Muhammad M.
通讯作者：
Yaqoob, Muhammad M.
异丙酚给药时机影响远程缺血预处理诱导大鼠心脏保护的有效性
影响因子：
4
作者：
Chen, Ke;Yu, Junma;Lu, Yao
通讯作者：
Lu, Yao
影响因子：
2
作者：
Higgins, JPT;Thompson, SG
通讯作者：
Thompson, SG