马根山预防对比剂急性肾损害（CIAKI ） 的 策 略课件.pptVIP

* * This meta-analysis reviewed publications in a variety of databases and languages published between 1966 and November 2006 to search for randomized controlled trials that 1) administered NAC, theophylline, fenoldopam, dopamine, iloprost, statin, furosemide or mannitol to a treatment group, 2) used IV iodinated CM, 3) explicitly defined CIN and 4) reported sufficient data to construct a 2X2 table of the primary effect measure (ref, p284). The initial database search resulted in 619 citations and references; after the final screening, 41 randomized clinical trials involving 6379 patients met the inclusion criteria (ref, p286). The 26 trials using NAC showed mixed results; although some of the studies demonstrated a significant benefit of NAC in reducing the risk of CIN, other studies did not demonstrate any benefit. The overall results, shown on this slide, demonstrate that NAC reduced the risk for CIN more than saline alone (RR 0.62 [95% CI 0.44 to 0.88] (ref, p284). However, significant subgroup heterogeneity was present for NAC (ref, p284). A previous meta-analysis of 20 clinical trials (Nallamothu, p938), in which 16 of the trials were in common with the meta-analysis of Kelly reported here, did not find NAC to significantly reduce the incidence of CIN (RR 0.73 [95% CI 0.52 to 1.03]). In addition, 4 of the trials described earlier which investigated the use of bicarbonate for volume expansion also treated the patients with NAC (these 4 trials are not included in the Kelly meta-analysis depicted on this slide): although the prophylactic effect of NAC was not the primary objective in these trials, NAC did did not appear to decrease the incidence of CIN (Recio-Mayoral A. JACC 2007 [slide 30]; Briguori C et al. Circulation 2007 [slide 31]; Ozcan EE et al. Am Heart J. 2007 [slide 31]; From AM et al. Clin J Am Soc Nephrol 2008 [slide 32]). References: Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-analysis: Effectiveness of drugs for preventing contr