肝移植手术内血管活性药物和术后结果:系统性审查和网络元分析
François Martin Carrier1,2,3,4, Martin Girard1,2,3,4, Rui Min Zuo5
1Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.
Transplantation
|August 1, 2023
概括
这一系统性审查发现,肝移植期间使用手术内血管活性药物对急性损伤 (AKI) 没有显著改善. 与诺亚上腺素相比,烯和特里普林减少了血液损失.
科学领域:
- 麻醉学和外科手术期间的医学.
- 移植手术 移植手术
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 血管活性药物在肝移植期间管理血液动力学方面至关重要.
- 急性损伤 (AKI) 是肝移植接受者的重大并发症.
- 血管活性剂的最佳选择仍在争论中.
研究的目的:
- 在成年肝移植接受者中,系统地审查和网络地进行血管活性药物对AKI和术后结果的影响的元分析.
- 根据其作用机制,比较不同类别和特定的血管活性药物剂.
主要方法:
- 随机对照试验 (RCT) 的系统审查和频率网络元分析.
- 在多个数据库中搜索了与成年肝移植接受者静脉注射血管活性药物进行比较的RCT.
- 使用推,评估,开发和评估 (GRADE) 的分级来评估证据质量 (QoE).
主要成果:
- 克隆因与更短的机械通风和住院时间 (非常低的QOE) 相关.
- 一些血管扩张剂与手术后24小时内肌水平降低有关 (低至非常低的QOE).
- 乙烯和特里普林显示,手术期间的血液损失比诺拉上腺素 (低至中等QOE) 低.
- 没有血管活性药物显示AKI或其他术后结果有所改善.
结论:
- 目前的证据表明,大多数术内血管活性药物在肝移植中对AKI的益处有限.
- 乙烯和特里普林可能有利于减少手术期间的血液损失.
- 需要进一步进行高质量的研究,以指导在这种患者群体中选择最佳的血管活性剂.
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