芬诺多巴姆用于预防和治疗急性损伤
Christopher I Esezobor1,2, Girish C Bhatt3, Emmanuel E Effa4
1Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.
The Cochrane database of systematic reviews
|November 28, 2024
概括
与安慰剂相比,芬诺多巴姆可以降低急性损伤 (AKI) 的风险,并缩短ICU停留时间. 然而,它对多巴胺或N-乙半氨酸 (NAC) 和心脏手术患者的有效性需要进一步研究.
科学领域:
- 药理学和病学 药理学和病学
- 关键护理医学 关键护理医学
- 基于证据的医学基于证据的医学.
背景情况:
- 芬诺多巴姆是一种选择性DA1受体激动剂,增加脏血液流动.
- 现有的关于芬诺多巴姆治疗急性损伤 (AKI) 的审查有局限性,包括联合预防/治疗数据,专注于特定人群 (心脏手术) 或排除儿童.
研究的目的:
- 评估芬诺多巴姆在儿童和成人中预防或治疗AKI的益处和危害.
- 综合来自随机对照试验 (RCT) 关于芬诺多巴姆在AKI中的有效性和安全性的证据.
主要方法:
- 对25项涉及3339名参与者的RCT进行了系统审查和元分析.
- 搜索了主要的数据库,包括Cochrane脏和移植注册表,CENTRAL,MEDLINE,EMBASE,ICTRP和临床试验.gov.gov.
- 使用GRADE方法评估偏差风险和证据确定性;分类结果作为相对风险 (RR) 报告,连续结果作为平均差异 (MD) 报告,具有95%的置信区间 (CI).
主要成果:
- 与安慰剂/盐水相比,芬诺多巴姆可能降低了AKI发生率 (RR 0.72),并可能缩短ICU停留时间 (MD-1.81天),对AKI减少具有中等确定性.
- 在代疗法 (KRT) 或死亡 (低确定性) 方面,对于芬诺多帕姆与安慰剂/盐水之间观察到的差异很小或不存在.
- 与多巴胺或N-乙半氨酸 (NAC) 相比,芬诺多巴姆的疗效及其对心脏手术患者的益处仍然存在不确定性,大多数结果的确定性证据非常低至低.
结论:
- 芬诺多巴姆可能会降低AKI风险和ICU停留与风险患者的安慰剂相比,但证据表明对KRT或死亡率有重大影响是有限的.
- 心脏手术患者的益处尚不清楚,与多巴胺或NAC的比较显示了不确定的结果.
- 需要进一步的精心设计,充足的RCT来确定芬诺多巴姆在AKI预防和治疗中的有效性和安全性.
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