网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
围术期泵注右美托咪定对肾移植受者术后肾功能影响的Meta分析
作者:荣进1  何东明1  胡蝶1  孙萌2  余周2  向琳琳1  赵思龙1 
单位:1. 遵义医科大学 第一临床医学院, 贵州 遵义 563000;
2. 遂宁市中心医院 泌尿外科, 四川 遂宁 629000
关键词:肾移植 右美托咪定 移植肾功能延迟恢复 急性肾移植排斥反应 肌酐 
分类号:R692
出版年·卷·期(页码):2024·52·第一期(25-35)
摘要:

目的:右美托咪定是否能改善肾移植(kidney transplantation,KT)患者肾功能尚存在争议。本文对围术期泵注右美托咪定与肾移植受者术后肾功能恢复的关系进行了Meta分析。方法:检索知网、万方、Pubmed、Embase、Cochrane、Web of Science等数据库,搜集关于围手术期泵注右美托咪定对肾移植受者术后肾功能恢复影响的临床研究。筛选出的主要评价指标是移植物功能延迟恢复(delayed graft function,DGF)、急性肾移植排斥反应(acute renal transplant rejection,ARTR)、感染。各项筛选出的评价指标采用随机效应模型进行Meta分析,异质性检验采用I2检验,发表偏倚采用漏斗图检验。结果:总共7篇文献(其中6篇为随机对照试验,1篇为回顾性研究),共1 223例患者纳入本篇Meta分析。与对照组相比,实验组在DGF[OR=0.71, 95%CI(0.52, 0.97)]、感染[OR=0.51, 95%CI(0.33, 0.78)]、术后第2天血肌酐(MD=-0.21,95%CI(-0.37,-0.06)]、住院时间(MD=-0.87,95%CI(-1.61,-0.13)]获得明显改善。结论:围术期泵注右美托咪定可能有助于减少肾移植患者术后的缺血再灌注损伤。

Objective: There is a controversy regarding whether dexmedetomidine can improve renal function in postoperative kidney transplant recipients. Therefore, this study conducted a Meta-analysis on the relationship between perioperative infusion of dexmedetomidine and postoperative renal function recovery in kidney transplant recipients. Methods: The author searched clinical studies on the impact of perioperative infusion of DEX on postoperative renal function recovery in kidney transplant recipients from databases such as CNKI, Wanfang, Pubmed, Embase, Cochrane, Web of Science. The primary outcomes were delayed graft function(DGF), acute renal transplant rejection(ARTR)infection. Results: Seven studies were included in this Meta-analysis(including 6 randomized controlled trials and 1 retrospective study) with 1 223 patients. Compared with the control group, the experimental group showed significant improvements in delayed graft function[OR=0.71, 95%CI(0.52, 0.97)], infection(OR=0.51, 95%CI(0.33, 0.78)], postoperative day 2 creatinine(MD=-0.21, 95%CI(-0.37,-0.06)] and length of hospital stay(MD=-0.87, 95%CI(-1.61,-0.13)]. Conclusion: Perioperative infusion of dexmedetomidine may help reduce ischemia-reperfusion injury in kidney transplant patients.

参考文献:

[1] THURET R,TIMSIT M O,KLEINCLAUSS F.Insuffisance rénale chronique et transplantation rénale[J].Prog Urol,2016,26(15):882-908.
[2] SANTOS B P,VIEGAS A D,FEIJO A M,et al.It was/wasn't everything I had imagined:advantages and disadvantages after kidney transplantation[J].Rev Gaucha Enferm,2016,37(3):e60135.
[3] PANZER O,MOITRA V,SLADEN R N.Pharmacology of sedative-analgesic agents:dexmedetomidine,remifentanil,ketamine,volatile anesthetics,and the role of peripheral mu antagonists[J].Anesthesiol Clin,2011,29(4):587-605.
[4] YUKI K.The immunomodulatory mechanism of dexmedetomidine[J].Int Immunopharmacol,2021,97:107709.
[5] FAYED N A,SAYED E I,SALEH S M,et al.Effect of dexmedetomidine on hepatic ischemia-reperfusion injury in the setting of adult living donor liver transplantation[J].Clin Transplant,2016,30(4):470-482.
[6] WEBB C A,WEYKER P D,FLYNN B C,et al.Asystole after orthotopic lung transplantation:examining the interaction of cardiac denervation and dexmedetomidine[J].Case Rep Anesthesiol,2012,2012:203240-203244.
[7] JOOSTE E H,MUHLY W T,IBINSON J W,et al.Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing routine cardiac catheterization[J].Anesth Analg,2010,111(6):1490-1496.
[8] DONG A,ZHANG Y,LU S,et al.Influence of dexmedetomidine on myocardial injury in patients with simultaneous pancreas-kidney transplantation[J].Evid Based Complement,2022,2022:1-8.
[9] 魏昕,周素素,高玮,等.右美托咪定在亲属活体肾移植受体手术麻醉中的应用[J].器官移植,2015(6):410-414.
[10] 刘瑶,李冰,吴亚辉,等.右美托咪定对异体肾移植患者围术期肾功能的影响[J].临床麻醉学杂志,2017,33(8):751-754.
[11] CHEN J,PEREZ R,MATTOS A M,et al.Perioperative dexmedetomidine improves outcomes of kidney transplant[J].Clin Transl Sci,2020,13(6):1279-1287.
[12] LIU Z,JIN Y,FENG C,et al.Renoprotective effect of intraoperative dexmedetomidine in renal transplantation[J].Comput Math Methods Med,2022,2022:1-11.
[13] WANG Y,WANG M,LEE C,et al.Effects of perioperative dexmedetomidine infusion on renal function and microcirculation in kidney transplant recipients:a randomised controlled trial[J].Ann Med,2022,54(1):1233-1243.
[14] SHAN X,HU L,WANG Y,et al.Effect of perioperative dexmedetomidine on delayed graft function following a donation-after-cardiac-death kidney transplant[J].Jama Netw Open,2022,5(6):e2215217.
[15] PARK J H,KOO B,KIM M,et al.Effects of intraoperative dexmedetomidine infusion on renal function in elective living donor kidney transplantation:a randomized controlled trial[J].Can J Anaesth,2022,69(4):448-459.
[16] HIGGINS J P T,ALTMAN D G,GOTZSCHE P C,et al.The cochrane collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,343 (2):d5928.
[17] STANG A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in Meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.
[18] WANG W,LI X,YIN H,et al.Factors affecting the long-term renal allograft survival[J].Chin Med J,2011,124(8):1181-1184.
[19] MELIH K V,BOYNUEGRI B,MUSTAFA C,et al.Incidence,risk factors,and outcomes of delayed graft function in deceased donor kidney transplantation[J].Transplantat Proc,2019,51(4):1096-1100.
[20] SCHINSTOCK C,STEGALL M D.Acute antibody-mediated rejection in renal transplantation:current clinical management[J].Curr Transplant Rep,2014,1(2):78-85.
[21] GROSSO G,CORONA D,MISTRETTA A,et al.Delayed graft function and long-term outcome in kidney transplantation[J].Transplantation Proceedings,2012,44(7):1879-1883.
[22] JASSEM W,ROAKE J.The molecular and cellular basis of reperfusion injury following organ transplantation[J].Transplant Rev,1998,12(1):14-33.
[23] MCCORD J M.Oxygen-derived free radicals in postischemic tissue injury[J].NEJM,1985,312(3):159-163.
[24] CHULUYAN H E,SCHALL T J,YOSHIMURA T,et al.IL-1 activation of endothelium supports VLA-4(CD49d/CD29)-mediated monocyte transendothelial migration to C5a,MIP-1 alpha,RANTES,and PAF but inhibits migration to MCP-1:a regulatory role for endothelium-derived MCP-1[J].J Leukoc Biol,1995,58(1):71-79.
[25] LEHR H A,GUHLMANN A,NOLTE D,et al.Leukotrienes as mediators in ischemia-reperfusion injury in a microcirculation model in the hamster[J].J Clin Invest,1991,87(6):2036-2041.
[26] WANG K, WU M, XU J, et al. Effects of dexmedetomidine on per ioperative stress, inflammation, and immune function: systematic rev iew and Meta-analysis[J]. Br J Anaesth, 2019, 123(6): 777-794.
[27] YUKI K.The immunomodulatory mechanism of dexmedetomidine[J].Int Immunopharmacol,2021,97:107709.
[28] PANZER O, MOITRA V, SLADEN R N. Pharmacology of sedative-an algesic agents: dexmedetomidine, dexmedetomidine,ketamine, volatile anesthetics, and the role of peripheral mu antagonists[J].Anesthesiol Clin, 2011,29 (4): 587.
[29] ALANGADEN G J,THYAGARAJAN R,GRUBER S A,et al.Infectious complications after kidney transplantation:current epidemiology and associated risk factors[J].Clin Transplant,2006,20(4):401-409.
[30] COWAN J,BENNETT A,FERGUSSON N,et al.Incidence rate of post-kidney transplant infection:a retrospective cohort study examining infection rates at a large canadian multicenter tertiary-care facility[J].Can J Kidney Health Dis,2018,5:1063822303.
[31] WU X,DONG Y,LIU Y,et al.The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation:a meta-analysis[J].Am J Infect Control,2016,44(11):1261-1268.
[32] CHAN S,PASCOE E M,CLAYTON P A,et al.Infection-related mortality in recipients of a kidney transplant in Australia and New Zealand[J].Clin J Am Soc Nephrol,2019,14(10):1484-1492.
[33] JANJUA H S,HAINS D S,MAHAN J D.Kidney transplantation in the United States:economic burden and recent trends analysis[J].Progr Transplant,2013,23(1):78-83.
[34] NADERI M,ASLANI J,HASHEMI M,et al.Prolonged rehospitalizations following renal transplantation:causes,risk factors,and outcomes[J].Transplant Proc,2007,39(4):978-980.
[35] KHOSROSHAHI H T,OSKUI R,SHOJA M M,et al.Time-dependent variations in urine output after renal transplantation[J].Transplant Proc,2007,39(4):932-933.
[36] ARDALAN M R,ARGANI H,MORTAZAVI M,et al.More urine is better after renal transplantation[J].Transplant Proc,2003,35(7):2612-2613.
[37] KLEIN K,RVBENACKER S,SCHAEFER S M,et al.Tissue expression of aquaporin 2 is correlated to urine output and allograft function in sensitized kidney transplant patients[J].Transplan Proc,2016,48(8):2629-2636.
[38] KIM J,PYEON T,CHOI J I,et al.A retrospective study of the relationship between postoperative urine output and one year transplanted kidney function[J].BMC Anesthesiol,2019,19(1):231.
[39] LAI Q,PRETAGOSTINI R,POLI L,et al.Early urine output predicts graft survival after kidney transplantation[J].Transplantat Proc,2010,42(4):1090-1092.
[40] NORBERTO,PERICO D C M H.Delayed graft function in kidney transplantation[J].Lancet,2004,364:1814-1827.
[41] AULAKH N K,GARG K,BOSE A,et al.Influence of hemodynamics and intra-operative hydration on biochemical outcome of renal transplant recipients[J].J Anaesthesiol Clin Pharmacol,2015,31(2):174-179.
[42] SALVADORI M,ROSATI A,BOCK A,et al.Estimated one-year glomerular filtration rate is the best predictor of long-term graft function following renal transplant[J].Transplant,2006,81(2):202-206.
[43] ZHOU S,ZHAO W,LIN T,et al.Serum cystatin C can detect impaired graft function early after renal transplantation[J].Int J Clin Exp Med 2015,8(9): 16379.
[44] Matteucci E,Carmellini M,Bertoni C,et al.Urinary excretion rates of multiple renal indicators after kidney transplantation:clinical significance for early graft outcome[J].Ren Fail,1998,20(2):325-330.
[45] MOTA A P,MENEZES C A,ALPOIM P N,et al.Regulatory and pro-inflammatory cytokines in Brazilian living-related renal transplant recipients according to creatinine plasma levels[J].Nephrology,2018,23(9):867-875.
[46] LI F K,HO S K N,YIP T P S,et al.Cystatin C assay for the detection of renal dysfunction in Chinese renal transplant recipients[J].Clinica Chimica Acta,2002,322(1):133-137.
[47] TSAI J P,WU S W,HUNG T W,et al.Diagnostic performance of serum cystatin C and serum creatinine in the prediction of chronic kidney disease in renal transplant recipients[J].Transplant Proc,2010,42(10):4530-4533.
[48] VISVARDIS G,GRIVEAS I,ZILIDOU R,et al.Glomerular filtration rate estimation in renal transplant patients based on serum cystatin-C levels:comparison with other markers of glomerular filtration rate[J].Transplant Proc,2004,36(6):1757-1759.
[49] BRØCHNER-MORTENSEN J,HAMMERICH B,CHRISTOFFERSEN J.Assessment of renal function from plasma urea and plasma creatinine in children[J].Scand J Urol Nephrol,1982,16(3):229.
[50] PAN P,BINJIE H,MIN L,et al.A Meta-analysis on diagnostic value of serum cystatin C and creatinine for the evaluation of glomerular filtration function in renal transplant patients[J].Afri Health Sci,2014,14(4):1025-1035.
[51] FEHRMAN E I,SKEPPHOLM L.Renal function in the elderly(>70 years old)measured by means of iohexol clearance,serum creatinine,serum urea and estimated clearance[J].Scand J Urol Nephrol,2004,38(1):73-77.
[52] RAJU D L,GROVER V K,SHOKER A.Limitations of glomerular filtration rate equations in the renal transplant patient[J].Clin Transplant,2005,19(2):259-268.
[53] ALMOND A,SIDDIQUI S,ROBERTSON S,et al.Comparison of combined urea and creatinine clearance and prediction equations as measures of residual renal function when GFR is low[J].QJM,2008,101(8):619-624.
[54] PERALTA C A.Detection of chronic kidney disease with creatinine,cystatin C,and urine albumin-to-creatinine ratio and association with progression to end-stage renal disease and mortality[J].JAMA,2011,305(15):1545.
[55] LIU X,MA H,WANG C,et al.Is the chronic kidney disease epidemiology collaboration creatinine-cystatin C equation useful for glomerular filtration rate estimation in the elderly?[J].Clin Interv Aging,2013:1387.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 750960 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541