国际麻醉学与复苏杂志   2018, Issue (12): 0-0
    
左西孟旦对合并左心功能不全患者心脏手术预后影响的Meta分析
邱云, 高素敏, 孙虹, 王婷婷, 张劲松1()
1.南京医科大学附属淮安第一医院
Efficacy of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery: a Meta-analysis
 全文:
摘要:

目的 系统评价钙增敏剂左西孟旦对存在严重左心功能不全患者心脏手术预后的影响。 方法 计算机检索PubMed、EMBASE及Cochrane临床试验数据库,纳入建库至2017年7月发表的关于左西孟旦对合并左心功能不全患者心脏手术预后影响的随机对照研究(randomized controlled trial, RCT)。利用RevMan 5.3软件进行Meta分析。观察指标包括术后早期病死率、急性肾损伤、血液净化及血流动力学变化等指标。 结果 纳入9篇研究、1 464例患者,左西孟旦组736例、对照组728例。与对照组比较,左西孟旦可显著降低术后早期病死率[比值比(odds ratio, OR)=0.5,95%CI:0.31~0.81,P=0.004],同时减少了急性肾损伤的发生率和血液净化的治疗[OR=0.5,95%CI:0.32~0.78,P=0.003;OR=0.54,95%CI:0.32~0.90,P=0.03],而两组间的低血压及心律失常的发生率差异无统计学意义[OR=1.29,95%CI:0.83~1.99,P=0.26;OR=0.65,95%CI:0.32~1.35,P=0.25]。 结论 围手术期应用左西孟旦可以改善左心功能不全患者心脏手术的临床预后,减少并发症的发生。本研究纳入样本量较小,结论尚需更大规模高质量RCT证实。

关键词: 左西孟旦; 心功能不全; 心脏手术; 生存率; 急性肾损伤
Abstract:

Objective To explore the effect of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. Methods Databases including PubMed, EMBASE and Cochrane database were systematically queried to identify randomized controlled trial (RCT) research regarding levosimendan treatment for patients with left ventricular dysfunction undergoing cardiac surgery published from inception to July 2017. Meta-analysis was performed using RevMan 5.3. Relevant outcomes included early mortality, acute kidney injury, need for renal replacement therapy, hypotension and arrhythmia. Results Nine literatures with a total of 1 464 participants were included, with 736 patients in levosimendan group and 728 patients in control group respectively. Compared with control drugs, levosimendan reduced early mortality [odds ratio (OR)=0.5, 95% confidence interval (CI): 0.31-0.81, P=0.004], the incidence of acute kidney injury (OR=0.5, 95%CI: 0.32-0.78, P=0.003) and renal replacement therapy (OR=0.54, 95%CI: 0.32-0.90, P=0.03) in patients undergoing cardiac surgery, but did not affect the incidence of hypotension and arrhythmias (OR=1.29, 95%CI: 0.83-1.99, P=0.26. OR=0.65, 95%CI: 0.32-1.35, P=0.25). Conclusions Perioperative administration of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery may improve patient′s prognosis and reduce complications. The scope of this study is small, so more high quality RCT research are needed to provide more conclusive evidence regarding the benefit of this drug.

Key words: Levosimendan; Cardiac insufficiency; Cardiac surgery; Mortality; Acute kidney injury