Non-invasive remote ischemic preconditioning for patients with heart failure undergoing cardiac catheterization: a network meta-analysis of randomized controlled trials.

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiothoracic Surgery Pub Date : 2024-10-01 DOI:10.1186/s13019-024-03082-2
Li-Jun Cao, Wen-Juan Wang, Qin-Xue Zhou
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Abstract

Objective: This study aimed to evaluate the efficacy of six non-invasive remote ischemic preconditioning (RIPC) interventions during the nursing care of patients with heart failure (HF) prior to cardiac catheterization.

Methods: A comprehensive search of nine Chinese and English online databases was conducted from the date of their inception to June 2023 to identify randomized controlled trials (RCTs) investigating RIPC in patients with HF prior to cardiac catheterization. Two independent investigators screened the articles, extracted data, and assessed their quality. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and a network meta-analysis was conducted using R software.

Results: Four trials involving 511 patients with a low risk of bias were included in the analysis. Six non-invasive RIPC interventions were identified, all demonstrating effectiveness in reducing the incidence of contrast-induced acute kidney injury (CI-AKI). Among these, Intervention F (applying up to 50 mmHg above the resting systolic pressure for 5 min to the dominant leg or upper limb, repeated three times with an 18-minute interval) was deemed optimal, although the timing of the procedure was not specified. Intervention D (applying up to 200 mmHg pressure to the upper limb for 5 min, repeated four times with 5-minute intervals, within 45 min prior to cardiac catheterization, ) was considered suboptimal.

Conclusion: Although Intervention D was recommended as the preferred option, none of the four trials examined its impact on the cardiac function of patients with HF. Large-scale, multi-center RCTs are required, with outcome indicators including cardiac function and the occurrence of CI-AKI, to better understand the therapeutic effects of RIPC on HF and reduce the incidence of CI-AKI. This will provide a more robust foundation for clinical practice.

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对接受心导管检查的心力衰竭患者进行无创远程缺血预处理:随机对照试验的网络荟萃分析。
研究目的本研究旨在评估心导管检查前心力衰竭(HF)患者护理过程中六种无创远程缺血预处理(RIPC)干预措施的疗效:方法:对九个中英文在线数据库进行了全面检索,检索时间从数据库建立之日起至2023年6月,目的是找出研究心导管检查前心衰患者远程缺血预处理的随机对照试验(RCT)。两名独立研究人员筛选了文章、提取了数据并评估了文章质量。使用Cochrane偏倚风险工具评估了偏倚风险,并使用R软件进行了网络荟萃分析:纳入分析的四项试验涉及 511 名患者,偏倚风险较低。确定了六种无创 RIPC 干预方法,所有方法都能有效降低造影剂诱发急性肾损伤(CI-AKI)的发生率。其中,干预方法 F(对优势腿或上肢施加高于静息收缩压 50 mmHg 的压力,持续 5 分钟,重复三次,每次间隔 18 分钟)被认为是最佳干预方法,但没有明确说明操作的时间。干预措施 D(在心导管检查前 45 分钟内,对上肢施加高达 200 mmHg 的压力,持续 5 分钟,重复 4 次,每次间隔 5 分钟)被认为是次优方案:结论:尽管干预措施 D 被推荐为首选方案,但四项试验均未研究其对心房颤动患者心脏功能的影响。为了更好地了解 RIPC 对心房颤动的治疗效果并降低 CI-AKI 的发生率,需要进行大规模、多中心的 RCT 试验,其结果指标包括心功能和 CI-AKI 的发生率。这将为临床实践提供更坚实的基础。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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