胃部手术后加速康复与传统康复随机对照的荟萃分析  

A Meta-analysis of Randomized Controlled Trials of Accelerated Rehabilitation and Traditional Rehabilitation After Gastric Surgery

作　　者：蒋雨 冯吉 朱和林 李雪萍[1,2] JIANG Yu;FENG Ji;ZHU He-lin;LI Xue-ping(School of Clinical Medicine,Xi’an Medical University,Xi’an 710021,Shaanxi,China;Xi'an Key Laboratory for Prevention and Treatment of Common Aging Diseases/Translation and Research Centre for Prevention and Therapy of Chronic Disease/Institute of Basic and Translation Medicine/Xi'an Medical University,Xi’an 710021,Shaanxi,China)

机构地区：[1]西安医学院临床医学院,陕西西安710021 [2]西安市常见老龄疾病防治重点实验室/慢病防治研究与转化中心/基础与转化医学研究所/西安医学院,陕西西安710021

出　　处：《医学信息》2023年第22期1-7,共7页Journal of Medical Information

基　　金：陕西省重点研发计划项目(编号:2021ZDLSF02-09)。

摘　　要：目的探讨加速康复外科(ERAS)在胃外科手术中的安全性和有效性。方法检索PubMed、Web of Knowledge、EMbase和Cochrane图书馆建库至2022年3月14日关于胃部手术(胃癌和减重手术)的术后患者接受ERAS方案和传统护理康复的随机对照试验(RCTs)。运用Review Manager 5.4软件和Stata 12.0软件进行统计分析。结果最终共纳入13项RCTs。Meta分析显示,ERAS组术后并发症发生率、术后24 h的VAS评分、住院花费低于CC组,术中出血量少于CC组,总住院时间、术后住院时间、首次排气时间、首次排便时间、首次流质饮食时间、首次下床活动时间均短于CC组,差异有统计学意义(P<0.05)。ERAS组和CC组Clavien-DindoⅢa级以上并发症发生率、手术时间、再手术发生率、再住院发生率和术后死亡率比较,差异无统计学意义(P>0.05)。结论在胃外科手术中,ERAS方案可在一定程度上有利于减少术后并发症,加速术后恢复,节省医疗费用,且不增加患者再手术、再入院等术后短期死亡率等额外负担的风险。Objective To investigate the safety and efficacy of enhanced recovery after surgery(ERAS)in gastric surgery.Methods Randomized controlled trials(RCTs)involving ERAS protocols for gastric surgery(gastric cancer and bariatric surgery)and conventional care recovery in PubMed,Web of Knowledge,EMbase and Cochrane library from database inception to March 14,2022 were searched.All data in this study were statistically analyzed using Review Manager 5.4 software and Stata 12.0 software.Results Finally,a total of 13 RCTs were included.Meta-analysis showed that the incidence of postoperative complications,VAS score at 24 h after operation and hospitalization cost in the ERAS group were lower than those in the CC group,and the intraoperative blood loss was less than that in the CC group,the total hospitalization time,postoperative hospitalization time,first exhaust time,first defecation time,first liquid diet time and first ambulation time in the ERAS group were shorter than those in the CC group,with statistically significant differences(P<0.05).There was no significant difference in the incidence of complications above Clavien-DindoⅢa,operation time,reoperation rate,rehospitalization rate and postoperative mortality between the ERAS group and the CC group(P>0.05).Conclusion In gastric surgery,the ERAS program is beneficial to reduce postoperative complications,accelerate postoperative recovery,save medical costs,and does not increase the risk of additional short-term mortality such as re-operation and re-admission.

关 键 词：加速康复外科 胃癌 胃切除术 减重手术 随机对照试验 

分 类 号：R735.2[医药卫生—肿瘤]