{"title":"围手术期右美托咪定对肾移植术后移植功能延迟的影响：系统综述和荟萃分析。","authors":"","doi":"10.1016/j.bjane.2024.844534","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.</p></div><div><h3>Methods</h3><p>Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.</p></div><div><h3>Results</h3><p>Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, <em>p</em> = 0.03, GRADE: Very low, I<sup>2</sup> = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, <em>p</em> = 0.003, GRADE: Very low, I<sup>2</sup> = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, <em>p</em> < 0.0001, GRADE: Very low, I<sup>2</sup> = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, <em>p</em> < 0.00001, GRADE: Very low, I<sup>2</sup> = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, <em>p</em> = 0.005, GRADE: Very low, I<sup>2</sup> = 87%).</p></div><div><h3>Conclusions</h3><p>This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.</p></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"74 6","pages":"Article 844534"},"PeriodicalIF":1.7000,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0104001424000563/pdfft?md5=46fdc47c6ff8452713c73241e99369fa&pid=1-s2.0-S0104001424000563-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis\",\"authors\":\"\",\"doi\":\"10.1016/j.bjane.2024.844534\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.</p></div><div><h3>Methods</h3><p>Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.</p></div><div><h3>Results</h3><p>Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, <em>p</em> = 0.03, GRADE: Very low, I<sup>2</sup> = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, <em>p</em> = 0.003, GRADE: Very low, I<sup>2</sup> = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, <em>p</em> < 0.0001, GRADE: Very low, I<sup>2</sup> = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, <em>p</em> < 0.00001, GRADE: Very low, I<sup>2</sup> = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, <em>p</em> = 0.005, GRADE: Very low, I<sup>2</sup> = 87%).</p></div><div><h3>Conclusions</h3><p>This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.</p></div>\",\"PeriodicalId\":32356,\"journal\":{\"name\":\"Brazilian Journal of Anesthesiology\",\"volume\":\"74 6\",\"pages\":\"Article 844534\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0104001424000563/pdfft?md5=46fdc47c6ff8452713c73241e99369fa&pid=1-s2.0-S0104001424000563-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Brazilian Journal of Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0104001424000563\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brazilian Journal of Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0104001424000563","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：右美托咪定是一种高选择性α-2肾上腺素受体激动剂，具有镇静和镇痛作用，最近的研究表明它具有肾脏保护特性。右美托咪定可降低移植功能延迟的发生率，并有助于有效控制肾移植后的疼痛。本系统综述的主要目的是评估右美托咪定是否能降低肾移植患者移植物功能延迟的发生率：方法：对包括 MEDLINE、EMBASE 和 CENTRAL 在内的数据库进行了全面检索，检索时间从开始到 2023 年 3 月。纳入标准包括所有随机临床试验（RCT）和观察性研究，对接受肾移植手术的成年患者进行右美托咪定与对照组的比较。排除病例系列和病例报告：共有 10 项 RCT（涉及 1,358 名患者）符合数据综合的资格标准。与对照组相比，右美托咪定组的移植物功能延迟发生率显著降低（OR = 0.71，95% CI 0.52-0.97，p = 0.03，GRADE：极低，I2 = 0%）。右美托咪定还显著延长了开始抢救性镇痛的时间（MD = 6.73，95% CI 2.32-11.14，p = 0.003，GRADE：极低，I2 = 93%），并减少了肾移植后吗啡的总体用量（MD = -5.43，95% CI -7.95--2.91，p < 0.0001，GRADE：极低，I2 = 0%）。与对照组相比，右美托咪定组的心率（MD = -8.15，95% CI -11.45 to -4.86，p < 0.00001，GRADE：很低，I2 = 84%）和平均动脉压（MD = -6.66，95% CI -11.27 to -2.04，p = 0.005，GRADE：很低，I2 = 87%）显著下降：这项荟萃分析表明，右美托咪定有可能降低移植功能延迟的发生率，与对照组相比，右美托咪定在成人肾移植手术中的镇痛效果更好。然而，高度的异质性和样本量的不足突出表明，今后需要进行充分的试验来证实这些发现。
Effects of perioperative dexmedetomidine on delayed graft function following renal transplant: a systematic review and meta-analysis
Background
Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.
Methods
Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.
Results
Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).
Conclusions
This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
