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目的:系统评价右美托咪定干预对体外循环下心脏术后急性肾损伤(AKI)的预防作用。方法:计算机检索PubMed、EBSCO、中国知网、万方数据库、超星数据库、维普数据库,收集关于右美托咪定干预下心脏手术相关的临床随机对照试验(RCTs),检索日期从建库至2019年2月。由两位研究者独立筛选文献、搜集资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入8个RCTs,共1 043名患者。Meta分析结果显示:与对照组相比,右美托咪定干预能够显著减少术后AKI的发生(OR=0.53;95%CI:0.370.74;P=0.000 3),但在机械通气时间(MD=-0.44;95%CI:-2.081.20;P=0.60)、ICU停留时间(MD=-1.04;95%CI:-2.420.35;P=0.14)、住院时间(MD=-0.41;95%CI:-1.380.57;P=0.42)、死亡情况(OR=0.33;95%CI:0.101.11;P=0.07)方面无明显差异。结论:右美托咪定可预防体外循环下心脏术后AKI的发生,但因受纳入研究质量的限制,上述结论仍需更多高质量的研究予以论证。
Abstract：Objective:To evaluate the efficacy of dexmedetomidine(Dex)in prevention of acute kidney injury(AKI)after cardiac surgery under cardiopulmonary bypass.Methods:The relevant randomized controlled trials(RCTs)about cardiac surgery under the intervention of Dex were collected from database of PubMed,EBSCO,CNKI,Wanfang,Chaoxing and Vip until February 2019.Two researchers independently screened the literature,collected data,and evaluated the bias risk of included studies.The meta analysis was performed by RevMan 5.3 software.Results:There were 8 RCTs included,with a total of 1 043 patients.The results of meta analysis indicated that Dex can significantly reduce the incidence of postoperative AKI compared with the control group(OR=0.53;95% CI:0.37 to 0.74;P=0.000 3).However,there were no significant differences in the time of mechanical ventilation(MD=-0.44;95% CI:-2.08 to 1.20;P =0.60),ICU stay(MD=-1.04;95% CI:-2.42 to 0.35;P=0.14),the duration of hospital stay(MD=-0.41;95% CI:-1.38 to 0.57;P=0.42),and postoperative mortality(OR=0.33;95% CI:0.10 to 1.11;P=0.07).Conclusion:Dex could reduce the occurrence of AKI after cardiac surgery under cardiopulmonary bypass,which still needs more high quality trails to prove owing to the limited quality of the included studies.
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基本信息:
中图分类号:R614
引用信息:
[1]黎梦媛,陈春.右美托咪定在预防心脏术后急性肾损伤中的应用：Meta分析[J].巴楚医学,2020,3(01):71-77.
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