The organ protective effects of penehyclidine hydrochloride (PHC) in patients undergoing cardiac surgery: a systematic review and meta-analysis.
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BACKGROUND: As a novel selective anticholinergic drug, penehyclidine hydrochloride (PHC) provided the potential to protect organs by inhibiting the inflammatory response, attenuating oxidative stress, and alleviating ischemia / reperfusion injury. This study aimed to evaluate the organ protective effects of PHC in patients undergoing cardiac surgery. METHODS: Six electronic databases were searched systematically for randomized-controlled trials (RCTs) published April 30th 2025 that explored the application of PHC on cardiac surgical patients. Primary outcomes of interest included the biomarkers and variables of major organs (e.g. heart, lung, gastrointestinal tract and immune system) injury. Secondary outcomes of interest included the mechanical ventilation duration and hospital length of stay (LOS). Mean difference (MD) with 95% confidence interval (CI) or odds ratios (OR) with 95% CI were employed to analyze the data. RESULTS: A total of 37 RCTs with 1929 cardiac surgical patients (PHC group, 1043 patients; Control group, 886 patients) were included. The current study demonstrated that the adult patients in PHC group had lower cardiac troponin I (cTnI) [MD: -1.70, 95%CI: -2.63 to -0.77, P = 0.0003, with heterogeneity (P < 0.00001)] and creatine kinase (CK)-MB levels on post-operative day (POD)-1 after cardiac surgery, while the pediatric patients had lower cardiac troponin T (cTnT) (MD: -0.10, 95%CI: -0.12 to -0.09, P < 0.00001, without heterogeneity) in PHC group on POD-1. The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were significantly lower in both adult and pediatric patients of PHC group on POD-1. The incidence of postoperative pulmonary infection was significantly reduced in the PHC group, and the duration of mechanical ventilation and hospital LOS were shortened in adult patients. CONCLUSIONS: This meta-analysis demonstrated that PHC could provide myocardial protection and suppress the inflammatory response in patients undergoing cardiac surgery, thereby potentially facilitating rapid recovery. CLINICAL TRIAL NUMBER: PROSPERO registration number CRD42020183260.