背景:右美托咪定,一种具有镇静和镇痛作用的高选择性α-2肾上腺素受体激动剂,在最近的研究中已经提出具有肾脏保护特性。右美托咪定可降低移植肾功能延迟的发生率,并有助于有效控制肾移植术后的疼痛。本系统评价的主要目的是评估右美托咪定是否能降低肾移植患者移植肾功能延迟的发生。
方法:包括MEDLINE、EMBASE,和CENTRAL从成立到2023年3月进行了全面搜索。纳入标准涵盖所有随机临床试验(RCTs)和观察性研究,比较右美托咪定与对照组在接受肾移植手术的成年患者中的差异。排除包括病例系列和病例报告。
结果:涉及1,358名患者的10个RCT符合数据合成的合格标准。与对照组相比,右美托咪定组移植功能延迟的发生率显著降低(OR=0.71,95%CI0.52-0.97,p=0.03,GRADE:非常低,I2=0%)。右美托咪定还显著延长了开始抢救镇痛的时间(MD=6.73,95%CI2.32-11.14,p=0.003,等级:非常低,I2=93%)和减少肾移植后的总吗啡消耗量(MD=-5.43,95%CI-7.95至-2.91,p<0.0001,等级:非常低,I2=0%)。右美托咪定组心率显著降低(MD=-8.15,95%CI-11.45至-4.86,p<0.00001,等级:非常低,I2=84%)和与对照组相比的平均动脉压(MD=-6.66,95%CI-11.27至-2.04,p=0.005,等级:非常低,I2=87%)。
结论:这项荟萃分析提示右美托咪定可能会降低移植功能延迟的发生率,并在接受肾移植的成人患者中提供优于对照组的镇痛方案。然而,高度的异质性和不充分的样本量突出表明,未来有必要进行足够有效的试验来证实这些发现.
BACKGROUND: Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties.
Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients.
METHODS: Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports.
RESULTS: Ten RCTs involving a total of 1,358 patients met the eligibility criteria for data synthesis. Compared to the control group, the
dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52-0.97, p = 0.03, GRADE: Very low, I2 = 0%).
Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32-11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The
dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%).
CONCLUSIONS: This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.