背景:DelNido心脏停搏液(DNC)已广泛用于接受心脏手术的儿科人群。然而,因此,它在成人心脏手术中的使用受到限制,它的好处还不完全清楚。进行此分析是为了评估DNC对正在接受心脏手术的成年患者的任何其他类型的心脏停搏液的影响。
方法:我们系统地搜索了PubMed,科克伦图书馆,和Scopus从数据库开始到2023年3月,并纳入了中等至高质量的随机对照试验,将DNC与其他心脏停搏液进行了比较。主要结果是术后卒中和/或短暂性脑缺血发作(TIA)。次要结果包括自发节律恢复,术后心肌梗死,全因死亡率,术后心房颤动,冠状动脉再灌注后除颤,术后主动脉内球囊反搏,术后肾损伤,术后低心输出量综合征,正性肌力支持,体外循环时间,交叉钳制时间,输血,心脏停搏液量,住院,重症监护室逗留,机械通气停留,术后左心室射血分数,和心脏标志物。
结果:在本荟萃分析中,包括13项研究,患者群体为2207。卒中和/或TIA研究(风险比[RR]:0.54,95%CI[0.29,1.00])和全因死亡率研究(RR:1.30,95%CI[0.66,2.56])均无统计学意义。从次要结果来看,自发节律恢复(RR:1.58,95%CI[1.02,2.45]),冠状动脉再灌注后除颤(RR:0.49,95%CI[0.30,0.79]),正性肌力支持(RR:0.70,95%CI[0.57,0.85]),卒中和/或TIA和/或急性肾损伤和死亡率的复合风险(RR:0.72,95%CI[0.53,0.99]),交叉钳位时间(平均差[MD]:-6.01,95%CI[-11.14,-0.89]),输血(RR:0.73,95%CI[0.60,0.90]),心脏停搏液体积(MD:-537.17,95%CI[-758.89,-315.45]),肌钙蛋白T(MD:-1.71,95%CI[-2.11,-1.32]),肌酸磷酸激酶-MB(MD:-2.96,95%CI[-5.84,-0.07])显着。而所有其他次要结果被发现是微不足道的。
结论:与其他心脏停搏液相比,接受DelNido给药的患者在主要结局方面没有显着差异,中风或/和TIA。
BACKGROUND: Del Nido cardioplegia (DNC) has extensively been used for pediatric population undergoing cardiac surgery. However, its use in adult cardiac surgeries have been limited thus, its benefits are not yet fully known. This analysis was performed to evaluate the impact of DNC versus any other type of cardioplegia in adult patients who are undergoing cardiac surgery.
METHODS: We systematically searched PubMed, Cochrane Library, and Scopus from database inception till March 2023, and moderate to high-quality randomized controlled trials were included which compared DNC to other cardioplegia. The primary outcome was postoperative stroke and/or transient ischemic attack (TIA). Secondary outcomes included spontaneous rhythm return, postoperative myocardial infarction, all-cause mortality, postoperative atrial fibrillation, defibrillation after coronary reperfusion, postoperative intra-aortic balloon pump, postoperative kidney injury, postoperative low cardiac output syndrome, inotropic support, cardiopulmonary bypass time, cross-clamp time, blood transfusion, cardioplegia volume, hospital stay, intensive care unit stay, mechanical ventilation stay, postoperative left ventricular ejection fraction, and cardiac markers.
RESULTS: In this meta-analysis, 13 studies were included with a patient population of 2207. Stroke and/or TIA studies (risk ratio [RR]: 0.54, 95% CI [0.29, 1.00]) and all-cause mortality studies (RR: 1.30, 95% CI [0.66, 2.56]) were insignificant. From the secondary outcomes, spontaneous rhythm return (RR: 1.58, 95% CI [1.02, 2.45]), defibrillation after coronary reperfusion (RR: 0.49, 95% CI [0.30, 0.79]), inotropic support (RR: 0.70, 95% CI [0.57, 0.85]), composite risk of stroke and/or TIA and/or acute kidney injury and mortality (RR: 0.72, 95% CI [0.53, 0.99]), cross-clamp time (mean difference [MD]: -6.01, 95% CI [-11.14, -0.89]), blood transfusion (RR: 0.73, 95% CI [0.60, 0.90]), cardioplegia volume (MD: -537.17, 95% CI [-758.89, -315.45]), troponin T (MD: -1.71, 95% CI [-2.11, -1.32]), creatine phosphokinase-MB (MD: -2.96, 95% CI [-5.84, -0.07]) were significant. Whereas all other secondary outcomes were found to be insignificant.
CONCLUSIONS: No significant difference was observed between patients undergoing Del Nido administration in comparison to other cardioplegia solutions for the primary outcome, stroke or/and TIA.