摘要
目的：系统评价快速康复外科（ ERAS）在肝切除围手术期应用的安全性和有效性。方法利用PubMed、Embase、Cochrane library、Sinomed、万方、维普和中国知网检索关于ERAS理念在肝切除围手术期应用的随机对照试验（ RCT），截止时间到2015年8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11项RCT、1074例患者纳入研究，其中ERAS组530例，对照组544例。 Meta分析结果显示：与对照组比较， ERAS 组住院时间显著缩短（WMD ＝－2．36，95％CI：－3．19～－1．54，P＜0．05），功能康复时间明显缩短（W MD＝－2．30，95％CI：－3．77～－0．83，P＜0．05），总并发症率降低（RR＝0．65，95％CI：0．52～0．80，P＜0．05）。其中术后肺部感染（RR＝0．36，95％C I：0．14～0．91，P＜0．05）、恶心及呕吐（RR＝0．48，95％CI：0．26～0．89， P＜0．05）的发生率显著降低，但术后出血、胆漏、腹腔感染、伤口延迟愈合、伤口感染、尿路感染发生率两组差异无统计学意义（P＞0．05）。 ERAS组住院费用显著降低（SMD＝－1．61，95％CI：－2．42～－0．80，P＜0．05）。两组病死率和再入院率差异无统计学意义（均P＞0．05）。 ERAS组腹腔引流管拔除时间（WMD＝－2．83，95％CI：－3．92～－1．76，P＜0．05）、首次下地活动时间（SMD＝－2．34，95％CI：－2．98～－1．70，P＜0．05）、首次进食时间（SMD＝－5.08，95％CI：－9.33～－0.83，P＜0.05）和首次排气时间（SMD＝－3．60，95％CI：－4．85～－2．34，P＜0．05）均较对照组明显提前。首次排便时间两组差异无统计学意义（P＞0．05）。结论快速康复外科应用于肝切除围手术期是安全的，患者可从中获益。
Objective To conduct a systematic review on the safety and efficacy of enhanced recov -ery after surgery （ ERAS） in perioperative management of hepatectomy .Methods A literature search was conducted on databases which included the PubMed , Embase, Cochrane Library, Sinomed, Wangfang, VIP and CNKI for randomized controlled trials （ RCTs） on application of ERAS in patients after hepatectomy . The data collection ended in August 2015.A meta-analysis was performed using RevMan 5.3 software.Re-sults Eleven RCTs which included 1074 patients were selected into this study .There were 530 patients in the ERAS group and 544 patients in the control group .On Meta-analysis, when compared with the control group, the ERAS group had significantly shorter length of hospital day （WMD=-2.36, 95%CI： -3.19～-1.54 , P〈0.05 ） , shorter time for functional recovery （ WMD=-2.30 , 95%CI： -3.77 ～-0.83 , P〈0.05）, lower total complication rate （RR=0.65, 95%CI：0.52～0.80, P〈0.05）, and significantly decreased rates of postoperative pulmonary infection （RR=0.36, 95%CI：0.14～0.91, P〈0.05） and nausea and vomiting （RR=0.48, 95%CI：0.26～0.89, P〈0.05）.There were no significant differences between the two groups on the rates of postoperative bleeding , biliary fistula, abdominal infection, delayed incisional healing, wound infection and urinary tract infection （P〉0.05）.The ERAS group had significant-ly lower hospitalization cost （SMD=-1.61, 95%CI：-2.42～-0.80, P〈0.05）, but the differences between the two groups on mortality and re-admission rates were not significant （P〉0.05）.When compared with the control group , the drainage tube removal time （ WMD=-2.83 , 95% CI：-3.92～-1.76 , P〈0.05）, time to first mobilization （SMD=-2.34, 95%CI：-2.98～-1.70, P〈0.05）, time to first feeding （ SMD=-5.08 , 95%CI： -9.33～-0.83 , P〈0.05） , time to passage of first flatus （ SMD=-3.60, 95%CI：-4.85～-2.34, P〈0.05） in the ERAS group were significantly shorter , but there was no significant difference on the time to the first bowel motion （ P〉0.05 ） .Conclusions ERAS in the peri-operative management of hepatectomy was safe and beneficial .
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2016年第6期361-366,共6页
Chinese Journal of Hepatobiliary Surgery
关键词
快速康复外科
肝切除
围手术期
META分析
Enhanced recovery after surgery
Hepatotectomy
Perioperative period
Meta- analysis
