Kai Zhuang , Hao-tian Yang , Yu-qin Long , Hong Liu , Fu-hai Ji , Ke Peng
{"title":"右美托咪定与非心脏手术后急性肾损伤：试验序列分析荟萃。","authors":"Kai Zhuang , Hao-tian Yang , Yu-qin Long , Hong Liu , Fu-hai Ji , Ke Peng","doi":"10.1016/j.accpm.2024.101359","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Acute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.</p></div><div><h3>Methods</h3><p>PubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.</p></div><div><h3>Results</h3><p>Twenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% <em>vs.</em> 13.2%; risk ratio = 0.57, 95% CI = 0.40–0.83, <em>P</em> = 0.003, <em>I<sup>2</sup></em> = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.</p></div><div><h3>Conclusion</h3><p>Dexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.</p></div><div><h3>Registration</h3><p>International Prospective Register of Systematic Reviews; Registration number: CRD42022299252.</p></div>","PeriodicalId":48762,"journal":{"name":"Anaesthesia Critical Care & Pain Medicine","volume":"43 3","pages":"Article 101359"},"PeriodicalIF":3.7000,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis\",\"authors\":\"Kai Zhuang , Hao-tian Yang , Yu-qin Long , Hong Liu , Fu-hai Ji , Ke Peng\",\"doi\":\"10.1016/j.accpm.2024.101359\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Acute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.</p></div><div><h3>Methods</h3><p>PubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.</p></div><div><h3>Results</h3><p>Twenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% <em>vs.</em> 13.2%; risk ratio = 0.57, 95% CI = 0.40–0.83, <em>P</em> = 0.003, <em>I<sup>2</sup></em> = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.</p></div><div><h3>Conclusion</h3><p>Dexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.</p></div><div><h3>Registration</h3><p>International Prospective Register of Systematic Reviews; Registration number: CRD42022299252.</p></div>\",\"PeriodicalId\":48762,\"journal\":{\"name\":\"Anaesthesia Critical Care & Pain Medicine\",\"volume\":\"43 3\",\"pages\":\"Article 101359\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-02-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anaesthesia Critical Care & Pain Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352556824000171\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia Critical Care & Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352556824000171","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：急性肾损伤（AKI）是外科手术后常见的并发症，与不利的预后有关。本系统综述和荟萃分析评估了围手术期右美托咪定对非心脏手术后AKI和肾功能的影响：截至 2023 年 8 月，我们在 PubMed、Embase 和 Cochrane Library 数据库中检索了比较右美托咪定与生理盐水对接受非心脏手术的成人 AKI 和肾功能影响的随机试验。主要结果是AKI的发生率（根据肾病改善全球结果或急性肾损伤网络标准）。采用随机效应模型进行了 Meta 分析。我们进行了敏感性分析、试验序列分析（TSA）和建议分级评估、发展和评价证据水平：结果：共纳入 23 项试验，涉及 2440 名患者。与生理盐水相比，右美托咪定能显著降低AKI的发生率（7.4% vs. 13.2%；风险比 = 0.57，95% CI = 0.40 to 0.83，P = 0.003，I2 = 0%；高水平证据）；TSA和敏感性分析表明了这一结果的稳健性。在肾功能和炎症参数方面，右美托咪定降低了血清肌酐、血尿素氮、胱抑素C、肿瘤坏死因子-α和白细胞介素-6，增加了尿量和估计肾小球滤过率。此外，右美托咪定还能减少术后恶心和呕吐，缩短住院时间。右美托咪定与心动过缓发生率增加有关，但与低血压无关：结论：右美托咪定可降低非心脏手术后AKI的发生率，改善肾功能。基于高水平的证据，建议将右美托咪定作为围手术期肾脏保护的一部分：注册：系统综述国际前瞻性注册；注册号：CRD420222992CRD42022299252。
Dexmedetomidine and acute kidney injury after non-cardiac surgery: A meta-analysis with trial sequential analysis
Background
Acute kidney injury (AKI) is a common complication after surgery and is associated with detrimental outcomes. This systematic review and meta-analysis evaluated perioperative dexmedetomidine on AKI and renal function after non-cardiac surgery.
Methods
PubMed, Embase, and Cochrane Library databases were searched until August 2023 for randomised trials comparing dexmedetomidine with normal saline on AKI and renal function in adults undergoing non-cardiac surgery. The primary outcome was the incidence of AKI (according to Kidney Disease Improving Global Outcomes or Acute Kidney Injury Network criteria). Meta-analysis was performed using a random-effect model. We conducted sensitivity analysis, trial sequential analysis (TSA), and Grading of Recommendations Assessment, Development and Evaluation level of evidence.
Results
Twenty-three trials involving 2440 patients were included. Dexmedetomidine administration, as compared to normal saline, significantly reduced the incidence of AKI (7.4% vs. 13.2%; risk ratio = 0.57, 95% CI = 0.40–0.83, P = 0.003, I2 = 0%; a high level of evidence); TSA and sensitivity analyses suggested the robustness of this outcome. For the renal function and inflammation parameters, dexmedetomidine decreased serum creatinine, blood urea nitrogen, cystatin C, tumour necrosis factor-α, and interleukin-6, and increased urine output and estimated glomerular filtration rate. Additionally, dexmedetomidine reduced postoperative nausea and vomiting and length of hospital stay. Dexmedetomidine was associated with an increased rate of bradycardia, but not hypotension.
Conclusion
Dexmedetomidine administration reduced the incidence of AKI and improved renal function after non-cardiac surgery. Based on a high level of evidence, dexmedetomidine is recommended as a component of perioperative renoprotection.
Registration
International Prospective Register of Systematic Reviews; Registration number: CRD42022299252.
期刊介绍：
Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
