左西孟旦对心脏手术患者死亡率及并发症影响的Meta分析

Meta-analysis of the effect of levosimendan on mortality and complications in patients undergoing cardiac surgery

目的研究左西孟旦对心脏手术患者的死亡率及并发症的影响。方法计算机检索Pubmed、EMBase和The Cochrane Library数据库,检索所有已发表的左西孟旦与安慰剂在心脏手术患者中的随机对照试验(RCT)进行系统评价,检索时限从建库开始至2018年8月止。由2名研究员独立进行文献筛选、资料提取和质量评价后,使用Stata 12.0软件进行Meta分析。结果本研究共纳入18个RCT研究,共2799例患者,Meta分析结果显示:与对照组相比,左西孟旦组可降低心脏手术后患者的死亡率(RR=0.75,95%CI:0.58~0.99,P=0.039);在并发症方面,左西孟旦组可降低急性肾损伤发生率(RR=0.70,95%CI:0.53~0.92,P=0.011)和低心排综合征发生率(RR=0.44,95%CI:0.25~0.77,P=0.004)。左西孟旦组不能降低术后心肌损伤发生率(RR=0.89,95%CI:0.70~1.13,P=0.351)和术后房颤发生率(RR=0.80,95%CI:0.56~1.14,P=0.212)。结论左西孟旦有益于心脏手术患者,可降低心脏手术患者的死亡率,减少术后并发症,改善预后。

Objective To investigate the efficacy of Levosimendan on mortality and prognosis in patients undergoing cardiac surgery.Methods PubMed,Embase and the Cochrane Library databases were searched up from starting of the web site to August 2018 for randomized controlled trials in assessing the effects of Levosimendan and placebo on cardiac surgery patients.Two reviewers independently screened literatures,extracted data and assessed the risk of bias of included studies,and then meta-analysis was performed using Stata 12.0 software.Results Eighteen randomized clinical trials with a total of 2799 patients were included in this review.Overall meta-analysis results demonstrated that levosimendan was associated with a significant reduction in mortality(RR=0.75,95%CI:0.58~0.99,P=0.039).In terms of complications,Levosimendan also reduced the risk of the incidence of acute kidney injury(RR=0.70,95%CI:0.53~0.92,P=0.011)and low cardiac output(RR=0.44,95%CI:0.25~0.77,P=0.004).The levosimendan group failed to reduce the incidence of postoperative myocardial injury(RR=0.89,95%CI:0.70~1.13,P=0.351)and the incidence of postoperative atrial fibrillation(RR=0.80,95%CI:0.56~1.14,P=0.212).Conclusion Levosimendan is beneficial to patients undergoing cardiac surgery.It can reduce the mortality of patients undergoing cardiac surgery,reduce postoperative complications,and improve prognosis.