远隔缺血预处理对肝切除术患者干预效果的系统评价与Meta分析

背景与目的：尽管大量的动物实验已证实远隔缺血预处理（RIPC）可显著改善肝切除术后残余肝早期的组织灌注和氧合作用，减少肝缺血-再灌注损伤（HIRI），改善手术预后，提高生存率。然而，在临床研究中关于RIPC减少HIRI的作用仍存在争议。因此，本研究通过Meta分析评价RIPC在肝切除术中的有效性和安全性，为临床提供循证参考。方法：检索多个国内外文献数据库，收集评估RIPC策略有效性和安全性的随机对照试验（RCT），检索时间段为建库至2022年5月。对纳入的RCT进行质量评价，采用Revman 5.3统计软件进行分析。主要评价指标为术后肝功能指标、手术时间、术中出血量、住院时间、主要手术并发症。结果：共纳入11项RCT，包含851例患者，其中RIPC组422例，对照组429例。Meta分析结果显示，两组术前各项肝功能指标差异均无统计学意义（均P>0.05）；术后第1天，RIPC组的丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）水平明显低于对照组（WMD=-74.92,95%CI=-126.18～-23.67,P=0.004;WMD=-66.37,95%CI=-106.4...

A systematic review and Meta-analysis of the intervention effect of remote ischemic preconditioning on patients undergoing hepatectomy

Background and Aims Although many animal experiments have confirmed that remote ischemic preconditioning (RIPC) can significantly improve the early tissue perfusion and oxygenation of the residual liver after hepatectomy, reduce the hepatic ischemia-reperfusion injury (HIRI), accelerate the surgical prognosis, and improve the survival rate. However, there is still controversy over the role of RIPC in relieving HIRI in clinical studies. Therefore, this study was conducted to evaluate the efficacy and safety of RIPC in hepatectomy through Meta-analysis to provide evidence-based information for clinical decision-making.Methods Randomized controlled trials (RCTs) evaluating the efficacy and safety of RIPC strategy were collected by searching several national and international literature databases. The search spanned the period from the inception of each database to May 2022. After data extraction and quality evaluation of the included studies, Meta-analysis was performed using RevMan 5.3 software. The main evaluation indicators were postoperative liver function parameters, operative time, intraoperative blood loss, length of postoperative hospital stay, and the major postoperative complications.Results A total of 11 RCTs were included, involving 851 patients, with 422 cases in the RIPC group and 429 cases in the control group. The results of Meta-analysis showed that there was no significant difference in each liver function parameter before operation between the two groups (all P>0.05); the levels of alanine transaminase (ALT) and aspartate transaminase (AST) on postoperative day (POD) 1 were significantly lower in RIPC group than those in control group (WMD=-74.92, 95% CI=-126.18--23.67, P=0.004; WMD=-66.37, 95% CI=-106.47--26.27, P=0.001), but significant heterogeneity existed among the studies (I2=98%; I2=95%), there were no significant differences in ALT and AST levels on POD 3 and 7 between the two groups (all P>0.05), and there were no significant differences in levels of total bilirubin and albumin on POD 1, 3 and 7 between the two groups (all P>0.05); no statistical differences were noted in other evaluation indicators between the two groups (all P>0.05).Conclusion The application of RIPC in hepatectomy offers limited clinical benefit and cannot alleviate liver injury caused by HIRI after hepatectomy. However, more high-quality multicenter RCT studies still need to verify the above conclusions. In addition, all current clinical studies are performed under propofol anesthesia or propofol combined with inhalation anesthesia, which is also a hot topic of debate.