吸入一氧化氮气体对外科手术后肾功能损伤和出血影响的meta分析

doi:10.3969/j.issn.1674-8115.2022.01.014

摘要/Abstract

摘要：

目的·评价吸入一氧化氮（nitric oxide，NO）气体对外科术后肾损伤和出血的影响。方法·系统检索中国知网、中国生物医学文献数据库、万方数据库、PubMed、Embase、Web of Science、Cochrane Library，检索时限为各数据库建库至2021年3月26日。中文以“外科手术”“一氧化氮”为关键词进行检索。英文以“nitric oxide”“surgical procedures，operative”“cardiac surgical procedures”“cardiac surgery”“transplantation”为主题词及自由词进行检索。按照预先制定的纳入及排除标准筛选文献。采用RevMan 5.3软件进行meta分析，观察结局指标为肾损伤发生率和出血发生率。结果·共纳入7篇符合标准的临床研究文献，共计外科患者689例，其中接受NO治疗337例，对照组352例。Meta分析结果显示，相较于对照组，外科手术后应用NO组肾损伤发生率降低，差异有统计学意义（RR=0.75，95% CI 0.61~0.92，P=0.005），而出血发生率差异无统计学意义（RR=0.79，95%CI 0.22~2.83，P=0.710）。结论·外科手术中应用NO不会增加患者的肾损伤和出血风险，且在体外循环手术中应用NO可能具有保护肾脏作用。

关键词: 一氧化氮, 肾损伤, 出血, 外科, meta分析

Abstract:

Objective·To evaluate the effects of inhaled nitric oxide on renal injury and hemorrhage after surgery.

Methods·China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), WanFang Data, PubMed, Embase, Web of Science and The Cochrane Library were searched systematically from the establishment of each database to March 26, 2021. “外科手术” and “一氧化氮” were used as Chinese keywords for retrieval. Correspondingly, the “nitric oxide”“surgical procedures, operative”“cardiac surgical procedures”“cardiac surgery” and “transplantation” were used as subject words and free words for searching. The literatures were screened according to the pre-established inclusion and exclusion criteria. Meta-analysis was performed by using RevMan 5.3. The study end points were the incidences of renal injury and hemorrhage.

Results·Seven literatures were included for analysis, with a total of 689 surgical patients. Of them, 337 received nitric oxide treatment and 352 received placebo treatment. Compared with the control group, patients treated with nitric oxide demonstrated a statistically difference in reducing the incidence of postoperative renal injury (RR= 0.75, 95%CI 0.61?0.92, P=0.005). There was no significant difference in the incidence of hemorrhage (RR=0.79, 95%CI 0.22?2.83, P=0.710) between the two groups.

Conclusion·Application of nitric oxide after surgery does not increase the risks of renal injury and hemorrhage. In contrast, the use of nitric oxide in cardiopulmonary bypass might protect renal function.

Key words: nitric oxide, renal injury, hemorrhage, surgery, meta-analysis

中图分类号:

R619⁺.9

钱德伟, 周任, 关礼春, 张航, 虞敏. 吸入一氧化氮气体对外科手术后肾功能损伤和出血影响的meta分析[J]. 上海交通大学学报(医学版), 2022, 42(1): 95-100.

Dewei QIAN, Ren ZHOU, Lichun GUAN, Hang ZHANG, Min YU. Meta-analysis of impacts of inhaled nitric oxide on postoperative renal injury and hemorrhage[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 95-100.

图/表 6

参考文献 32

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Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	No. of AKI/ No. of cases/n
Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	NO	Control
PERRIN （2006）^［13］	Adults，lung transplantation	20 ppm within 12 h，through inhalation	Placebo	Need for RRT	1/15	1/15
POTAPOV （2011）^［12］	Adults，LVAD placement	40 ppm within 48 h，through inhalation	Placebo	Need for RRT	10/73	8/77
FERNANDES （2011）^［11］	Adults，mitral stenosis and severe pulmonary hypertension	10 ppm within 48 h，through inhalation	Oxygen	Urine output <0.3 mL·kg^-1·h^-1	0/14	1/15
LANG （2014）^［15］	Adults，liver transplantation	80 ppm during liver transplantation，through inhalation	Nitrogen	Urine output <0.3 mL·kg^-1·h^-1	3/40	7/40
LEI （2018）^［5］	Adults， multiple valve replacement surgery	80 ppm within 24 h，through CPB and inhalation	Placebo	KDIGO criteria （SCr only）	58/117	81/127
KAMENSHCHIKOV （2019）^［14］	Adults， CABG	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr only）	1/30	3/30
KAMENSHCHIKOV （2020）^［16］	Adults， CABG， valve surgery， surgical reconstruction of the left ventricle	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr and urine output）	10/48	20/48

Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	No. of AKI/ No. of cases/n
Study（year）	Population	Protocol of NO therapy	Comparison	Definition of AKI	NO	Control
PERRIN （2006）^［13］	Adults，lung transplantation	20 ppm within 12 h，through inhalation	Placebo	Need for RRT	1/15	1/15
POTAPOV （2011）^［12］	Adults，LVAD placement	40 ppm within 48 h，through inhalation	Placebo	Need for RRT	10/73	8/77
FERNANDES （2011）^［11］	Adults，mitral stenosis and severe pulmonary hypertension	10 ppm within 48 h，through inhalation	Oxygen	Urine output <0.3 mL·kg^-1·h^-1	0/14	1/15
LANG （2014）^［15］	Adults，liver transplantation	80 ppm during liver transplantation，through inhalation	Nitrogen	Urine output <0.3 mL·kg^-1·h^-1	3/40	7/40
LEI （2018）^［5］	Adults， multiple valve replacement surgery	80 ppm within 24 h，through CPB and inhalation	Placebo	KDIGO criteria （SCr only）	58/117	81/127
KAMENSHCHIKOV （2019）^［14］	Adults， CABG	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr only）	1/30	3/30
KAMENSHCHIKOV （2020）^［16］	Adults， CABG， valve surgery， surgical reconstruction of the left ventricle	40 ppm through CPB	Standard CPB	KDIGO criteria （SCr and urine output）	10/48	20/48

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