快速康复外科在肾上腺手术围术期患者中有效性和安全性的Meta分析  

Efficacy and safety of fast track surgery in adrenalectomy: a meta-analysis

作　　者：王海燕[1] 王丽[1] 朱碧丽[1] 李玉梅[1] WANG Haiyan;WANG Li;ZHU Bili;LI Yumei(Huiqiao Medical Center,Nanfang Hospital,Southern Medical University,Guangzhou,510515,P.R.China)

机构地区：[1]南方医科大学南方医院惠侨医疗中心

出　　处：《中国循证医学杂志》2019年第10期1211-1216,共6页Chinese Journal of Evidence-based Medicine

基　　金：2018南方医院护理创优-循证实践专项资金（编号：2018EBNe015）

摘　　要：目的系统评价快速康复外科在肾上腺手术围术期患者中应用的有效性和安全性。方法计算机检索PubMed、EMbase、Web of Science、CNKI、WanFang Data和VIP数据库,搜集肾上腺手术围术期应用快速康复外科治疗的随机对照试验(RCT),检索时限均为建库至2019年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括1 034例患者。Meta分析结果显示:应用快速康复外科治疗患者的首次排气时间[MD=-17.16,95%CI(-21.86,-12.46),P<0.000 01]、术后导尿管留置时间[MD=-43.44,95%CI(-46.65,-40.23),P<0.000 01]及引流管留置时间[MD=-39.91,95%CI(-57.58,-22.23),P<0.000 01]更短,并发症发生率更低[OR=0.26,95%CI(0.17,0.39),P<0.000 01]。但两组患者手术时间[MD=-1.18,95%CI(-3.22,0.86),P=0.26]和术中出血量[MD=0.25,95%CI(-2.84,3.34),P=0.88]的差异无统计学意义。结论当前证据显示,相较于常规康复治疗,快速康复外科能更安全、有效地促进肾上腺手术患者术后恢复。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objectives To systematically review the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy. Methods PubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs) on the efficacy and safety of fast track surgery in perioperative patients with adrenalectomy from inception to January 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 1 034 patients were included. The results of meta-analysis showed that: fast track surgery in perioperative patients with adrenalectomy could shorten first exhaust time(MD=-17.16,95%CI-21.86 to-12.46, P<0.000 01), postoperative catheter indwelling time(MD=-43.44, 95%CI-46.65 to-40.23,P<0.000 01) and drainage tube indwelling time(MD=-39.91, 95%CI-57.58 to-22.23, P<0.000 01), and reduce the incidence of complications after adrenalectomy(OR=0.26, 95%CI 0.1 to 0.39, P<0.000 01). There were no statistically differences in operation time(MD=-1.18, 95%CI-3.22 to 0.86, P=0.26) and blood loss(MD=0.25, 95%CI-2.84 to 3.34,P=0.88) between two groups. Conclusions Current evidence shows that, compared with the conventional rehabilitation group, fast track surgery can promote postoperative recovery of patients with adrenalectomy more safely and effectively,which has clinical promotion value. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.

关 键 词：肾上腺手术 快速康复外科 围手术期 系统评价 META分析 随机对照试验 

分 类 号：R473.6[医药卫生—护理学]