Juanjuan Shao, Liangshan Wang, Chengcheng Shao, Yan Wang, Jin Li, Jianfeng Luo, Zhongtao Du, Xiaotong Hou
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引用次数: 0
Abstract
Background: Clinical trials have demonstrated the efficacy of recombinant human brain natriuretic peptide (rhBNP) in managing acute decompensated heart failure. Moreover, since rhBNP performs roles in hemodynamic regulation, neurohormonal balance, and renal function, rhBNP administration could benefit cardiac surgery patients. We conducted a systematic review and meta-analysis to evaluate the impact of perioperative rhBNP in cardiac surgery patients.
Methods: We conducted a comprehensive search of the MEDLINE, Embase, the Cochrane Library, CNKI, and WANFANG databases from January 1, 2007, until December 31, 2023, identifying randomized controlled trials (RCTs) that examined the use of rhBNP during cardiac surgery. We estimated the treatment effects of perioperative rhBNP administration using a random-effects meta-analysis. The primary cardiovascular endpoint was the change in left ventricular ejection fraction (LVEF); meanwhile, renal function was assessed using the 24-hour urine output, changes in estimated glomerular filtration rate (eGFR), and serum creatinine (SCr) levels. Additional parameters included pulmonary artery pressure (PAP), adverse event (AE) incidence, respiratory support duration, ICU length of stay (ICU LOS), hospital length of stay (hospital LOS), and tumor necrosis factor-α (TNF-α) levels.
Results: Our meta-analysis included 38 RCTs encompassing 2280 patients. The use of rhBNP in the perioperative period significantly enhanced LVEF compared to the control group (mean difference = 3.13 (95% CI [1.88, 4.37]; p < 0.00001). Additionally, rhBNP administration was associated with a significant increase in the 24-hour urine volume (mean difference = 401.42, 95% CI [253.06, 549.77]; p < 0.00001) and an improvement in eGFR (mean difference = 13.94, 95% CI [5.57, 22.31]; p = 0.001). Meanwhile, perioperative administration of rhBNP significantly reduced SCr levels (mean difference = -14.55, 95% CI [-22.04, -7.06]; p < 0.0001). In addition, rhBNP significantly decreased PAP, the incidence of AEs, the duration of respiratory support, ICU LOS, hospital LOS, and TNF-α levels.
Conclusions: These findings underscore the potential benefits of rhBNP as a perioperative treatment in patients undergoing cardiac surgery.
背景：临床试验已经证明重组人脑利钠肽（rhBNP）治疗急性失代偿性心力衰竭的疗效。此外，由于rhBNP在血流动力学调节、神经激素平衡和肾功能中发挥作用，因此给予rhBNP可能对心脏手术患者有益。我们进行了系统回顾和荟萃分析，以评估围手术期rhBNP对心脏手术患者的影响。方法：从2007年1月1日至2023年12月31日，我们对MEDLINE、Embase、Cochrane Library、CNKI和万方数据库进行了全面检索，确定了在心脏手术中使用rhBNP的随机对照试验（RCTs）。我们使用随机效应荟萃分析估计围手术期给药rhBNP的治疗效果。主要心血管终点为左室射血分数（LVEF）的变化；同时，通过24小时尿量、肾小球滤过率（eGFR）和血清肌酐（SCr）水平的变化来评估肾功能。其他参数包括肺动脉压（PAP）、不良事件（AE）发生率、呼吸支持持续时间、ICU住院时间（ICU LOS）、住院时间（hospital LOS）和肿瘤坏死因子-α (TNF-α)水平。结果：我们的荟萃分析包括38项随机对照试验，涵盖2280例患者。与对照组相比，围手术期使用rhBNP可显著提高LVEF(平均差异= 3.13 （95% CI [1.88, 4.37]; p < 0.00001）。此外，给予rhBNP与24小时尿量显著增加（平均差异= 401.42,95% CI [253.06, 549.77]; p < 0.00001）和eGFR改善（平均差异= 13.94,95% CI [5.57, 22.31]; p = 0.001）相关。同时，围手术期给予rhBNP可显著降低SCr水平（平均差异= -14.55,95% CI [-22.04, -7.06]; p < 0.0001）。此外，rhBNP显著降低PAP、ae发生率、呼吸支持持续时间、ICU LOS、医院LOS和TNF-α水平。结论：这些发现强调了rhBNP作为心脏手术患者围手术期治疗的潜在益处。
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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