先天性心脏手术后的低心输出量综合征(LCOS)的发生率高达25%。预防和治疗LCOS至关重要,因为LCOS与过度的发病率和死亡率相关。
本系统评价评估小儿心脏手术围手术期左西孟旦给药的安全性和有效性。
随机对照试验的系统评价。对疗效和探索性结局进行Meta分析。
在以下数据库中检索了文献(MEDLINE,EMBASE,WebofScienceandCENTRAL)从成立到2021年7月。
在18岁以下接受心脏手术的儿童中,比较左西孟旦与其他促性腺激素或安慰剂的随机对照试验。
9项纳入539名儿童的研究可以纳入系统评价。所有试验均研究左西孟旦与安慰剂的预防性给药(n=2),米力农(n=6)或多巴酚丁胺(n=1)。左西孟旦剂量差异很大,只有三项研究使用负荷剂量。左西孟旦降低了LCOS的发生率[风险比(RR)0.80][95%置信区间(CI),0.40至0.89,P=0.01]和心脏指数增加(MD0.17lmin-1m-2)(95%CI,0.06至0.28,P=0.003),而不影响其他结局(死亡率,ICU住院时间,住院时间,机械通气的持续时间,血清乳酸,中心静脉血氧饱和度,血清肌酸或急性肾损伤)。
在接受心脏手术的儿童中预防性使用左西孟旦可降低LCOS的发生率,并与其他促性腺激素或安慰剂相比增加心脏指数。这种效应没有转化为其他临床终点的改善。
Low cardiac output syndrome (LCOS) after congenital cardiac surgery has an incidence of up to 25%. Preventing and treating LCOS is of pivotal importance as LCOS is associated with excess morbidity and mortality.
This systematic
review assesses the safety and efficacy of peri-operative levosimendan administration in the setting of paediatric cardiac surgery.
Systematic
review of randomised controlled trials. Meta-analyses were performed on efficacy and exploratory outcomes.
Literature was searched in the following databases (MEDLINE, EMBASE, Web of Science and CENTRAL) from inception to July 2021.
Randomised controlled trials comparing levosimendan with other inotropes or placebo in children younger than 18 years of age undergoing cardiac surgery.
Nine studies enrolling a total of 539 children could be included in the systematic
review. All trials study the prophylactic administration of levosimendan in comparison with placebo ( n = 2), milrinone ( n = 6) or dobutamine ( n = 1). Levosimendan dosing varied considerably with only three studies using a loading dose. Levosimendan reduced the incidence of LCOS [risk ratio (RR) 0.80] [95% confidence interval (CI), 0.40 to 0.89, P = 0.01] and increased cardiac index (MD 0.17 l min -1 m -2 ) (95% CI, 0.06 to 0.28, P = 0.003) without affecting other outcomes (mortality, ICU length of stay, hospital length of stay, duration of mechanical ventilation, serum lactate, central venous oxygen saturation, serum creatine or acute kidney injury).
The prophylactic use of levosimendan in children undergoing cardiac surgery reduced the incidence of LCOS and increased cardiac index compared with other inotropes or placebo. This effect did not translate into an improvement of other clinical endpoints.