加速康复外科理念在肝切除术围手术期应用的Meta分析  

Application of enhanced recovery after surgery in perioperative period of hepatectomy: a Meta-analysis

作　　者：任龙 张淼[1] 张云[1] REN Long, ZHANG Miao, ZHANG Yun.(Department of General Surgery, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiang- su 214200, Chin)

机构地区：[1]江苏大学附属宜兴医院普外科,江苏宜兴214200

出　　处：《临床肝胆病杂志》2018年第3期573-578,共6页Journal of Clinical Hepatology

摘　　要：目的系统评价加速康复外科理念在肝切除术围手术期的应用价值。方法检索Pub Med、EMBase、Cochrane图书馆、Sinomed,万方、维普、中国知网等数据库,文献检索起止时间均从建库至2017年7月。对纳入文献进行质量评价和数据提取,应用Revman 5.3软件进行Meta分析。结果共纳入17篇文献,其中随机对照试验14篇,半随机对照试验3篇。共收集2220例患者,其中加速康复组1002例,对照组1218例。相比于对照组,加速康复组术后住院时间[加权均数差(WMD)=-2.58,95%置信区间(95%CI):-3.47^-1.70,P<0.05]、功能康复时间(WMD=-3.39,95%CI:-4.32^-2.45,P<0.05)、首次排气时间[标准化均数差(SMD)=-1.56,95%CI:-2.15^-0.97,P<0.05]均缩短;并发症发生率降低[比值比(OR)=0.64,95%CI:0.52~0.78,P<0.05];住院费用明显减少(SMD=-0.85,95%CI:-1.23^-0.47,P<0.05)。而再入院率(OR=1.28,95%CI:0.69~2.69,P>0.05)、手术时间(WMD=-11.36,95%CI:-23.25~0.53,P>0.05)和术中出血(WMD=-22.62,95%CI:-38.89^-6.34,P>0.05)并没有明显差异。结论加速康复外科理念应用于肝切除术围手术期是安全有效的,值得推广。Objective To systematically review the value of enhanced recovery after surgery（ ERAS） in the perioperative period of hepatectomy. Methods A literature search was conducted in Pub Med,Embase,Cochrane Library,Sinomed,Wanfang Data,VIP,and CNKI to identify the articles on the application of ERAS in the perioperative period of hepatectomy published up to July 2017. Quality evaluation and data extraction were performed for the included articles. A Meta-analysis was performed using Revman 5. 3 software. Results A total of 17 articles were included,with 14 randomized controlled trials and 3 controlled clinical trials. A total of 2220 patients were involved and divided into ERAS group（ n = 1002） and control group（ n = 1218）. Compared with the control group,the ERAS group had significantly shortened length of postoperative hospital stay（ weighted mean difference [WMD]=-2. 58,95% confidence interval [CI]：-3. 47 to-1. 70,P 0. 05）,functional rehabilitation time（ WMD =-3. 39,95% CI：-4. 32 to-2. 45,P 0. 05）,and time to first flatus（ standardized mean difference [SMD]=-1. 56,95% CI：-2. 15 to-0. 97,P 0. 05）,as well as reduced complication rate（ odds ratio [OR]= 0. 64,95%CI： 0. 52-0. 78,P 0. 05） and hospital costs（ SMD =-0. 85,95% CI：-1. 23 to-0. 47,P 0. 05）. There were no significant differences between the two groups in readmission rate（ OR = 1. 28,95% CI： 0. 69-2. 69,P 0. 05）,operation time（ WMD =-11. 36,95% CI：-23. 25 to 0. 53,P 0. 05）,and intraoperative blood loss（ WMD =-22. 62,95% CI：-38. 89 to-6. 34,P 0. 05）. Conclusion ERAS is safe and effective in the perioperative period of hepatectomy and holds promise for clinical application.

关 键 词：加速康复外科 肝切除术 手术期间 META分析 

分 类 号：R657.3[医药卫生—外科学]