临床研究(Clinical Research)

加速康复外科在肝脏手术围手术期应用的Meta 分析

Published at: 2016年第25卷第1期

宋伟 1 , 邹书兵 1
1 南昌大学第二附属医院 肝胆外科,江西 南昌 330000
通讯作者 书兵 邹 Email: zousb999@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.01.018
基金:
江西省卫生厅科技计划资助项目 20151BB70158

摘要

目的:系统评价加速康复外科(ERAS)在肝脏手术围手术期应用的有效性及安全性。方法:计算机检索国内外多个数据库,收集关于ERAS 在肝脏围手术期应用的随机对照试验(RCT),检索时限均为从建库至2015 年6 月;由2 名独立研究者根据纳入与排除标准对文献进行筛选、提取资料和评价质量后,采用RevMan 5.3 软件进行Meta 分析。结果: 最终纳入9 项RCT, 共1 140 例患者, 其中ERAS 组555 例, 对照组( 传统围手术期处理)585 例。Meta 分析结果显示,与对照组比较,ERAS 组术后总并发症发生率明显降低(RR=0.58,95% CI=0.45~0.75,P<0.05),住院时间明显缩短(WMD=-2.47,95% CI=-3.14~-1.79,P<0.05), 首次排气时间明显提前(SMD=-0.90,95% CI=-1.43~-0.36,P<0.05),住院费用明显减少(SMD=-0.91,95% CI=-1.38~-0.44,P<0.05),术中出血量也明显减少(WMD=-22.64,95% CI=-41.23~-4.05,P<0.05),但在术后出血、胆瘘、肝功能衰竭、胸腔积液的发生率及手术时间方面,两组差异无统计学意义(均P>0.05)。结论:ERAS 在肝脏手术围手术期应用是安全有效的,并且能缩短住院时间,减少术后并发症,加速患者康复。


Application of enhanced recovery after surgery in setting of liver surgery: a Meta-analysis

Abstract

Objective: To systematically review the effectiveness and safety of the use of enhanced recovery after surgery (ERAS) in the setting of liver surgery. Methods: The randomized controlled trials (RCTs) regarding using ERAS in the setting of liver surgery were collected by searching several national and international online databases. The retrieval time was from inception of the database to June 2015. Article screening, data extraction and quality assessment were performed by two independent reviewers according to the defined inclusion and exclusion criteria, and then, Meta-analysis was performed by using RevMan 5.3 software. Results: Nine RCTs were finally selected with a total of 1 140 patients composed of 555 cases in ERAS group and 585 cases (undergoing traditional perioperative management) in control group. The results of Metaanalysis showed that in ERAS group compared with control group, the incidence of postoperative complications (RR=0.58, 95% CI=0.45–0.75, P<0.05), length of hospital stay (WMD=–2.47, 95% CI=–3.14––1.79, P<0.05), time to first flatus (SMD=–0.90, 95% CI=–1.43––0.36, P<0.05), hospitalization costs (SMD=–0.91 95% CI= –1.38––0.44, P<0.05), and intraoperative blood loss (WMD=–22.64, 95% CI=–41.23––4.05, P<0.05) were all significantly decreased. There were no statistical differences between the two groups in respects of the incidence of postoperative bleeding, bile leakage, liver failure, pleural effusion as well as operative time (all P>0.05). Conclusion: Use of ERAS protocols in the setting of liver surgery is safe and effective, and it can also reduce the length of hospital stay and incidence of postoperative complications, and thereby accelerate postoperative recovery of the patients.


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引用

引用本文: 伟 宋, 书兵 邹. 加速康复外科在肝脏手术围手术期应用的Meta 分析[J]. 中国普通外科杂志, 2016, 25(1): 115-125.
Cite this article as: SONG Wei, ZOU Shubing . Application of enhanced recovery after surgery in setting of liver surgery: a Meta-analysis[J]. Chin J Gen Surg, 2016, 25(1): 115-125.