快速康复外科护理模式对骨科围手术期患者并发症影响的Meta分析  

Influence of enhanced recovery after surgery nursing model forperioperative patients in orthopaedic surgery on complications:a Meta-analysis

作　　者：张莉[1,2] 陶贵彦[2] 章江琳[1,3] 虎洁婷 张志刚[5] 张彩云 刘建妮[2] 赵娟[2] Zhang Li;Tao Guiyan;Zhang Jianglin;Hu Jieting;Zhang Zhigang;Zhang Caiyun;Liu Jianni;Zhao Juan(School of Nursing,Lanzhou University,Lanzhou 730000,China;Department of Orthopedics,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Pediatric Medicine,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Hematology,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of ICU,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Nursing,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学护理学院,730000 [2]兰州大学第一医院骨科,730000 [3]兰州大学第一医院小儿内科,730000 [4]兰州大学第一医院血液科,730000 [5]兰州大学第一医院ICU,730000 [6]兰州大学第一医院护理部,730000

出　　处：《中国实用护理杂志》2019年第18期1435-1440,F0003,共7页Chinese Journal of Practical Nursing

摘　　要：目的评价快速康复外科(ERAS)护理模式对骨科围手术期患者并发症的影响。方法计算机检索电子数据库The Cochrane Library、PubMed、Embase、Web of science、中国知网、万方及中国生物医学数据库,检索关于国内外ERAS护理模式在骨科围手术期患者中应用的随机对照试验,检索时限均为建库至2018年3月16日,根据纳入排除标准筛选文献并提取数据,采用RevMan 5.3对纳入研究进行Meta分析。结果共纳入25篇RCT文献,共计患者2 412例。Meta分析结果显示,试验组与对照组相比,深静脉血栓的发生率[RR=0.38,95%CI0.24~0.61,P<0.01]、肺部感染发生率[RR=0.26,95%CI0.10~0.67,P=0.005]、泌尿系感染发生率[RR=0.28,95%CI0.10~0.78,P=0.01]、便秘发生率[RR=0.30,95%CI0.17~0.56,P=0.0001]、腹胀发生率[RR=0.35,95%CI0.13~0.95,P=0.04]有统计学意义;术后住院时间、住院费用和患者满意度差异均有统计学意义(P<0.01);切口感染、压疮、恶心呕吐发生率无统计学意义(P>0.05)。结论与常规护理相比,ERAS护理模式能促进骨科围手术期患者康复,降低术后深静脉血栓、便秘、肺部感染、泌尿系感染的发生,对术后住院时间、住院费用和患者满意度均有积极影响,但还需多中心、大样本的临床试验进行验证。Objective To evaluate the influence of enhanced recovery after surgery(ERAS)nursing model for perioperative patients in orthopedic surgery on complications.Methods Computer-based search of electronic databases the Cochrane Library,PubMed,Embase,Web of Science,CNKI,WF and CBM Database to search for randomized controlled trials on the application of ERAS nursing models in orthopaedic patients at domestic and foreign before March 16,2018,data were selected and screened according to the inclusion and exclusion criteria.RevMan 5.3 was used for meta-analysis of the included studies.Results A total of 25 RCTs were included in the study and a total of 2 412 patients were included.Meta-analysis showed that the incidence of deep venous thrombos[RR=0.38,95%CI(0.24,0.61),P<0.01],and incidence of pulmonary infection[RR=0.26,95%CI(0.10,0.67),P=0.005],incidence of urinary tract infections[RR=0.28,95%CI(0.10,0.78),P=0.01],incidence of constipation[RR=0.30,95%CI(0.17,0.56),P=0.0001],The incidence of bloating[RR=0.35,95%CI(0.13,0.95),P=0.04],they were lower in the experimental group than in routine care,they were statistically significant.Incidence of incision infection[RR=0.75,95%CI(0.17,3.27),P=0.70],incidence of pressure sores[RR=0.34,95%CI(0.09,1.27),P=0.11],incidence of nausea and vomiting[RR=0.81,95%CI(0.52,1.25),P=0.34]were not statistically significant;postoperative hospital stay,hospitalization costs,and patient satisfaction were statistically significant.Conclusions Compared with routine care,the ERAS nursing model can promote the recovery of orthopedic patients during perioperative period,reduce postoperative deep venous thrombosis,constipation,pulmonary infection,urinary tract infection,postoperative hospital stay,hospitalization costs,and patient satisfaction.All have a positive impact,but more multicentre and large sample clinical trials are needed for validation.

关 键 词：围手术期 手术后并发症 快速康复外科 META分析 

分 类 号：R473.6[医药卫生—护理学]