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预防外科手术患者肾损伤的药物干预：系统文献综述与meta分析
翻译：佟睿 编辑：冯玉蓉 审校：曹莹
背景：这项系统评价的目的是总结随机对照试验（RCT）的结果，该试验评估了对接受手术治疗的患者进行肾脏保护的药物干预措施。
方法：我们通过Cochrane对照试验中央注册中心、MEDLINE和EMBASE进行检索，来对2019年8月23日之前的关于评估药物干预在围手术期肾脏保护中的应用的RCTs综述进行更新。共同的主要指标是30天死亡率和急性肾损伤(AKI)。合并效应估计以风险率(RR)(95%可信区间)表示。
结果：我们共收集了228个试验，纳入56047名患者。23项试验被认为在所有领域的偏倚风险都很低。心钠素(14个试验；n=2207)可降低30天死亡率(RR：0.63[0.41，0.97])和AKI发生率(RR：0.43[0.33，0.56])，且无异质性。这些效应在心脏手术和血管手术亚组中是一致的，并且在敏感性分析中仅限于偏倚风险较低的研究。在初步分析和心脏手术队列中，肌苷扩张剂(13次试验；n=2941)降低了死亡率(RR：0.71[0.53，0.94])和AKI发生率(RR：0.65[0.50，0.85])。血管升压药(4次试验；n=1047)降低了AKI发生率(RR：0.56[0.36，0.86])。在初步分析中，一氧化氮供体、α-2-激动剂和钙通道阻滞剂降低了AKI发生率，但排除了有偏倚风险的研究后并没有降低AKI发生率。总体而言，对效果估计的确定性评估较低。
结论：对于接受手术的患者，多种药物干预措施均可发挥有效的肾保护作用。
原始文献来源：Suraj Pathak, Guido Olivieri, Walid Mohamed, et al. Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis.[J].Br J Anesth, 2020 Aug 19;[Epub ahead of print] PMID:32828488.
Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis
Abstract
Background: The aim of this systematic review was to summarise the results of randomised controlled trials (RCTs) that have evaluated pharmacological interventions for renoprotection in people undergoing surgery.
Methods: Searches were conducted to update a previous review using the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to August 23, 2019. RCTs evaluating the use of pharmacological interventions for renal protection in the perioperative period were included. The co-primary outcome measures were 30-day mortality and acute kidney injury (AKI). Pooled effect estimates were expressed as risk ratios (RRs) (95% confidence intervals).
Results: We included 228 trials enrolling 56 047 patients. Twenty-three trials were considered to be at low risk of bias across all domains. Atrial natriuretic peptides (14 trials; n=2207) reduced 30-day mortality (RR: 0.63 [0.41, 0.97]) and AKI events (RR: 0.43 [0.33, 0.56]) without heterogeneity. These effects were consistent across cardiac surgery and vascular surgery subgroups, and in sensitivity analyses restricted to studies at low risk of bias. Inodilators (13 trials; n=2941) reduced mortality (RR: 0.71 [0.53, 0.94]) and AKI events (RR: 0.65 [0.50, 0.85]) in the primary analysis and in cardiac surgery cohorts. Vasopressors (4 trials; n=1047) reduced AKI (RR: 0.56 [0.36, 0.86]). Nitric oxide donors, alpha-2-agonists, and calcium channel blockers reduced AKI in primary analyses, but not after exclusion of studies at risk of bias. Overall, assessment of the certainty of the effect estimates was low.
Conclusions: There are multiple effective pharmacological renoprotective interventions for people undergoing surgery.
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