Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

作者全名："Tian, Chun; Wang, Aihua; Huang, He; Chen, Youwan"

作者地址："[Tian, Chun] Chongqing Med Univ, Dept Anesthesiol, Yongchuan Hosp, Chongqing 402160, Peoples R China; [Wang, Aihua; Chen, Youwan] Chongqing Yongchuan Dist Peoples Hosp, Dept Crit Care Med, Chongqing 402160, Peoples R China; [Huang, He] Chongqing Med Univ, Dept Anesthesiol, Affiliated Hosp 2, Chongqing 400010, Peoples R China"

通信作者："Chen, YW (通讯作者)，Chongqing Yongchuan Dist Peoples Hosp, Dept Crit Care Med, Chongqing 402160, Peoples R China.; Huang, H (通讯作者)，Chongqing Med Univ, Dept Anesthesiol, Affiliated Hosp 2, Chongqing 400010, Peoples R China."

来源：BMC ANESTHESIOLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001191306800002

JCR分区：Q2

影响因子：2.3

年份：2024

卷号：24

期号：1

开始页：　

结束页：　

文献类型：Review

关键词：Remote ischemic preconditioning; Ischemia-reperfusion injury; Hepatic ischemia-reperfusion injury; Hepatectomy; Liver resection

摘要："Background Animal experiments have confirmed that remote ischemic preconditioning (RIPC) can reduce hepatic ischemia-reperfusion injuries (HIRIs), significantly improving early tissue perfusion and oxygenation of the residual liver after resections, accelerating surgical prognoses, and improving survival rates. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies, which warrants clarification. This study aimed to evaluate the beneficial effects and applicability of RIPC in hepatectomy and to provide evidence-based information for clinical decision-making. Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC interventions were collected, comparing RIPC to no preconditioning in patients undergoing hepatectomies. This search spanned from database inception to January 2024. Data were extracted independently by two researchers according to the PRISMA guidelines. The primary outcomes assessed were postoperative alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) levels. The secondary outcomes assessed included duration of surgery and Pringle, length of postoperative hospital stay, intraoperative blood loss and transfusion, indocyanine green (ICG) clearance, hepatocyte apoptosis index, postoperative complications, and others. Results Ten RCTs were included in this meta-analysis, with a total of 865 patients (428 in the RIPC group and 437 in the control group). ALT levels in the RIPC group were lower than those in the control group on postoperative day (POD) 1 (WMD = - 59.24, 95% CI: - 115.04 to - 3.45; P = 0.04) and POD 3 (WMD = - 27.47, 95% CI: - 52.26 to - 2.68; P = 0.03). However, heterogeneities were significant (I-2 = 89% and I 2 = 78%), and ALT levels on POD 3 were unstable based on a sensitivity analysis. AST levels on POD 1 in the RIPC group were lower than those in the control group (WMD = - 50.03, 95% CI: - 94.35 to - 5.71; P = 0.03), but heterogeneity was also significant (I-2 = 81%). A subgroup analysis showed no significant differences in ALT and AST levels on POD 1 between groups, regardless of whether the Pringle maneuver or propofol was used for anesthesia (induction only or induction and maintenance, P > 0.05). The remaining outcome indicators were not statistically significant or could not be analyzed due to lack of sufficient data. Conclusion RIPC has some short-term liver protective effects on HIRIs during hepatectomies. However, there is still insufficient evidence to encourage its routine use to improve clinical outcomes."

基金机构："Chongqing Municipal Science and Health Joint Medical Research Project of China [2020FYYX033]; Natural Science Foundation of Yongchuan District, Chongqing, China (Ycstc) [2020nb0229]"

基金资助正文："This systematic review was funded by the Chongqing Municipal Science and Health Joint Medical Research Project of China (2020FYYX033), and the Natural Science Foundation of Yongchuan District, Chongqing, China (Ycstc, 2020nb0229)."