左西孟旦对左心功能不全心脏病患者围术期肾保护作用的系统评价与Meta分析

Levosimendan confers perioperative renoprotection in severe patients undergoing cardiac surgery: A systematic review and meta-analysis

目的评估左西孟旦在左心功能不全心脏手术患者[术前左室射血分数(LVEF)≤40.0%]中术后急性肾损伤(AKI)的防治作用。方法检索PubMed,EMbase和The Cochrane Library数据库中的随机对照试验(RCT)。检索时间为建库至2018年1月。临床研究终点包括AKI、肾脏替代治疗(RRT)、死亡率、机械通气(MV)时间和重症监护室(ICU)停留时间。由于存在潜在的临床异质性所有分析采用随机效应模型。采用RevMan 5.3和Stata 12.0进行统计分析。结果本研究纳入13篇RCTs共计2 046例患者。与对照组相比,左西孟旦明显降低术后AKI发生率[比值比(OR)=0.44,P=0.000 1,I^2=0%],RRT使用率(OR=0.63, P=0.02,I^2=0%)和死亡率(OR=0.49,P<0.000 1,I^2=0%)。另外,左西孟旦也能改善MV时间[加权均数差(WMD)=–5.62,P=0.07,I^2=93%]和ICU停留时间(WMD=–1.50,P=0.005,I^2=98%)。结论在合并左心室功能不全(LVEF≤40.0%)患者的心脏手术中,左西孟旦能降低术后AKI发生率、RRT使用率和死亡率,也能缩短术后MV时间和ICU停留时间。

Objective To evaluate the effect of levosimendan on acute kidney injury(AKI) in patients with left ventricular dysfunction(preoperative left ventricular ejection fraction≤40.0%) undergoing cardiac surgery. Methods A systematic review and meta-analysis was conducted based on a comprehensive search of the randomized controlled trial(RCT) from PubMed, EMbase and The Cochrane Library(up to Jan 2018). The clinical endpoints included the incidence of AKI and need for renal replacement therapy(RRT), mortality, mechanic ventilation(MV) duration and intensive care unit(ICU) stay. Random-effect model was used for the potential clinical inconsistency. All analyses were performed by RevMan 5.3 and Stata 12.0. Results Thirteen trials with a total of 2 046 patients were selected. Compared with controls,levosimendan significantly reduced the incidence of postoperative AKI(OR=0.44, P=0.000 1, I^2=0%), the risk of RRT(OR=0.63, P=0.02, I^2=0%) and the mortality(OR=0.49, P<0.000 1, I^2=0%). Levosimendan also shortened the postoperative MV duration(WMD=–5.62, P=0.07, I^2=93%) and ICU stay(WMD=–1.50, P=0.005, I^2=98%). Conclusion The present meta-analysis suggests that perioperative levosimendan for patients with left ventricular ejection fraction≤40.0%undergoing cardiac surgery reduces the incidence of AKI, RRT and death, as well as shortens MV duration and ICU stay.