摘要
目的:系统评价加速康复外科(ERAS)对根治性膀胱切除术病人康复效果的影响。方法:计算机检索中国知网(CNKI)、万方数据库(WanFang Database)、维普数据库(VIP)、PubMed、the Cochrane Library、Web of Science数据库,从建库至2021年5月31日发表的ERAS应用于根治性膀胱切除术病人围术期的文献。由2位研究员独立筛选纳入文献、提取资料并对纳入研究进行质量评价。采用RevMan 5.2软件进行Meta分析。结果:最终纳入19项研究,涉及1422例病人,其中ERAS组722例,对照组700例。Meta分析结果显示,与对照组相比,ERAS组术后首次排气时间更早[MD=-1.38,95%CI(-1.54,-1.22),P<0.05],总住院时间更短[MD=-4.84,95%CI(-6.08,-3.60),P<0.00001],住院费用更少[MD=-0.95,95%CI(-1.04,-0.86),P<0.00001],而且术后恶心呕吐发生率[OR=0.36,95%CI(0.16,0.78),P=0.01]、肺部感染发生率[OR=0.24,95%CI(0.09,0.65),P=0.005]、尿路感染发生率[OR=0.29,95%CI(0.13,0.62),P=0.002]、肠梗阻发生率[OR=0.43,95%CI(0.22,0.85),P=0.02]及术后并发症总发生率均更低[OR=0.27,95%CI(0.19,0.37),P<0.00001]。结论:现有证据表明,ERAS能促进根治性膀胱切除术病人的胃肠功能恢复,降低并发症发生率,缩短住院时间,减少住院费用,优化医疗资源。
Objective:To systematically evaluate the influence of ERAS on the rehabilitation effect of patients undergoing radical cystectomy.Methods:Literature on the application of ERAS in the perioperative period of patients with radical cystectomy were retrieved from CNKI,WanFang Database,VIP,PubMed,the Cochrane Library,and Web of Science.The retrieval time was from inception to May 31,2021.Two researchers independently screened the included literature,extracted data and evaluated the quality of the included research.Revman 5.2 software was used for Meta-analysis.Results:Finally,19 studies were included,involving 1422 patients,including 722 in the ERAS group and 700 in the control group.Meta-analysis results showed that,compared with the control group,ERAS group had earlier first exhaust time[MD=-1.38,95%CI(-1.54,-1.22),P<0.05],shorter total hospitalization time[MD=-4.84,95%CI(-6.08,-3.60),P<0.00001],less hospitalization expenses[MD=-0.95,95%CI(-1.04,-0.86),P<0.00001],and the incidence of postoperative nausea and vomiting[OR=0.36,95%CI(0.16,0.78),P=0.01],pulmonary infection[OR=0.24,95%CI(0.09,0.65),P=0.005],urinary tract infection[OR=0.29,95%CI(0.13,0.62),P=0.002],intestinal obstruction[OR=0.43,95%CI(0.22,0.85),P=0.02]and total postoperative complications[OR=0.27,95%CI(0.19,0.37),P<0.00001]were lower.Conclusions:Current evidence shows that ERAS can promote the recovery of gastrointestinal function in patients with radical cystectomy,reduce the incidence of complications,shorten the length of hospital stay,reduce hospital expenses and optimize medical resources.
作者
刘汉梅
张咏梅
赵茂晶
令狐玉双
辜甜田
LIU Hanmei;ZHANG Yongmei;ZHAO Maojing;LINGHU Yushuang;GU Tiantian(Affiliated Hospital of Zunyi Medical University,Guizhou 563003 China)
出处
《循证护理》
2022年第11期1438-1442,共5页
Chinese Evidence-Based Nursing
基金
遵义市科技计划项目,编号:遵市科合HZ字〔2021〕153号。
关键词
根治性膀胱切除术
加速康复外科
康复效果
META分析
循证护理
radical cystectomy
enhanced recovery after surgery
rehabilitation effect
Meta-analysis
evidence-based nursing
