Hongpei Li, Lei Wang, Chunxia Shi, Baolong Zhou, Lan Yao
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Meta-analyses were conducted using RevMan 5.4 models, and subgroup analyses were performed based on dexmedetomidine dosing and timing of administration. Continuous outcomes were combined and analyzed using either mean difference (M.D.), while dichotomous outcomes were analyzed using risk ratio (RR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Our study included a total of 14 trials involving 2744 patients. Dexmedetomidine administration significantly reduced the incidence of AKI compared to control groups (RR = 0.54, 95% CI: 0.41-0.70, <i>P</i> < 0.00001). Postoperative serum creatinine levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI: -0.28 to -0.001, <i>P</i> =0.04). Subgroup analyses revealed that higher initial doses (>0.5 μg/kg) and administration during intraoperative and postoperative periods were associated with more pronounced renoprotective effects. Dexmedetomidine did not significantly affect mortality but reduced the duration of the length of hospital stay and mechanical ventilation.</p><p><strong>Conclusions and relevance: </strong>This meta-analysis demonstrates that dexmedetomidine administration, particularly at higher doses and during both intraoperative and postoperative periods, reduces the risk of AKI in adults undergoing cardiac surgery. 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引用次数: 0
摘要
背景:急性肾损伤(AKI)是心脏手术后常见的严重并发症:急性肾损伤(AKI)是心脏手术后常见的严重并发症。右美托咪定是一种高选择性α2-肾上腺素能激动剂,具有潜在的肾脏保护作用,但之前的研究结果却相互矛盾:本荟萃分析旨在评估右美托咪定在预防AKI和降低接受心脏手术的成年患者术后血清肌酐水平方面的有效性和安全性:我们在 5 个数据库中全面检索了在成人心脏手术患者中比较右美托咪定与对照组的随机对照试验。主要结果是AKI的发生率和术后血清肌酐水平的变化。使用 RevMan 5.4 模型进行 Meta 分析,并根据右美托咪定的剂量和给药时间进行亚组分析。连续性结果采用平均差(M.D.)进行合并分析,二分法结果采用风险比(RR)和95%置信区间(CI)进行分析:我们的研究共包括 14 项试验,涉及 2744 名患者。与对照组相比,右美托咪定能显著降低 AKI 的发生率(RR = 0.54,95% CI:0.41-0.70,P <0.00001)。右美托咪定的术后血清肌酐水平也较低(MD = -0.14 mg/dL,95% CI:-0.28 至 -0.001,P =0.04)。亚组分析显示,初始剂量越大(>0.5 μg/kg),术中和术后用药的肾保护作用越明显。右美托咪定对死亡率没有显著影响,但缩短了住院时间和机械通气时间:这项荟萃分析表明,右美托咪定的用药,尤其是大剂量用药以及术中和术后用药,可降低接受心脏手术的成人发生 AKI 的风险。这些研究结果支持使用右美托咪定作为一种预防性策略,以提高这类人群的肾脏预后。
Impact of Dexmedetomidine Dosing and Timing on Acute Kidney Injury and Renal Outcomes After Cardiac Surgery: A Meta-Analytic Approach.
Background: Acute kidney injury (AKI) is a common and serious complication following cardiac surgery. Dexmedetomidine, a highly selective α2-adrenergic agonist, has shown potential renoprotective effects, but previous studies have yielded conflicting results.
Objective: This meta-analysis aimed to evaluate the efficacy and safety of dexmedetomidine in preventing AKI and reducing postoperative serum creatinine levels in adult patients undergoing cardiac surgery.
Methods: We comprehensively searched 5 databases for randomized controlled trials comparing dexmedetomidine with control groups in adult cardiac surgery patients. The main outcomes were the incidence of AKI and change in postoperative serum creatinine levels. Meta-analyses were conducted using RevMan 5.4 models, and subgroup analyses were performed based on dexmedetomidine dosing and timing of administration. Continuous outcomes were combined and analyzed using either mean difference (M.D.), while dichotomous outcomes were analyzed using risk ratio (RR) with 95% confidence intervals (CI).
Results: Our study included a total of 14 trials involving 2744 patients. Dexmedetomidine administration significantly reduced the incidence of AKI compared to control groups (RR = 0.54, 95% CI: 0.41-0.70, P < 0.00001). Postoperative serum creatinine levels were also lower with dexmedetomidine (MD = -0.14 mg/dL, 95% CI: -0.28 to -0.001, P =0.04). Subgroup analyses revealed that higher initial doses (>0.5 μg/kg) and administration during intraoperative and postoperative periods were associated with more pronounced renoprotective effects. Dexmedetomidine did not significantly affect mortality but reduced the duration of the length of hospital stay and mechanical ventilation.
Conclusions and relevance: This meta-analysis demonstrates that dexmedetomidine administration, particularly at higher doses and during both intraoperative and postoperative periods, reduces the risk of AKI in adults undergoing cardiac surgery. These findings support the use of dexmedetomidine as a preventive strategy to enhance renal outcomes in this population.
期刊介绍:
Annals of Pharmacotherapy (AOP) is a peer-reviewed journal that advances pharmacotherapy throughout the world by publishing high-quality research and review articles to achieve the most desired health outcomes.The articles provide cutting-edge information about the most efficient, safe and cost-effective pharmacotherapy for the treatment and prevention of various illnesses. This journal is a member of the Committee on Publication Ethics (COPE). Average time from submission to first decision: 14 days