妇科腹部手术术后快速康复外科路径的应用效果评价与meta分析

doi:10.3760/cma.j.issn.1007-1245.2022.05.020

摘要/Abstract

摘要： 目的　快速康复外科路径已被广泛接受且应用于不同类型的手术，但是在妇科腹部手术中的应用效果尚不明确。本文利用系统评价和meta分析的方法回顾了目前已有的证据，探讨快速康复外科理念对妇科腹部手术术后结局的影响。方法　采用Cochrane系统评价的方法，计算机检索PubMed、EMbase、Cochrane Library、CBM、CNKI、万方、VIP数据库，检索年限均从建库至2020年5月。严格按照纳入与排除标准收集关于快速康复外科理念在妇科腹部手术中的应用研究，研究中至少描述4条个体化干预措施。由2名评价员独立筛选文献、提取信息并评价质量，利用RevMan 5.3统计软件进行meta分析，结局指标包括住院时间、并发症发生率、再次入院率和病死率等。定量分析仅限于有对照组的研究。效应大小以相对危险度（RR）、均数（MD）及95%可信区间（CI）表述。结果　共纳入17项观察性研究。对纳入研究的异质性进行分析，所有路径都包括术前教育、早期口服药物治疗和早期动员。与传统的围术期处理相比，快速康复外科路径可以减少首次（MD=-2.10，95%CI：-2.67～-1.52）和总体的住院时间（MD=-3.42，95%CI：-3.96～-2.88），且不会增加并发症发生率、病死率和再次入院率。结论　虽然快速康复外科路径可能减少妇科腹部手术术后的住院时间，但是现有的证据均基于一系列偏倚风险较高的非随机对照研究，未来还需要高质量的研究来证实。

关键词: 妇科手术, 快速康复外科, 围术期管理, 住院时间

Abstract: Objective　Enhanced recovery after surgery has been widely accepted and implemented for different types of surgery. Their overall effect in abdominal gynecologic surgery is still underdetermined. A systematic review and meta-analysis were performed to provide an overview of current evidences and to examine their effect on postoperative outcomes in women undergoing open gynecologic surgery. Methods　We used systematic review research methods of Cochrane. The literatures were searched from PubMed, EMbase, Cochrane Library, CBM, CNKI, Wan Fang, and VIP databases from their establishment to May 2020. The studies applying enhanced recovery after surgery theory in abdominal gynecologic surgery which met the inclusion and exclusion criteria and had described 4 individualized intervention measures were collected. Two evaluators screened the literatures, extracted the information, and evaluated the quality independently. The meta-analysis was made by RevMan 5.3. The outcome indicators included hospital stay, incidence of complications, re-admission rate, and case fatality rate. Quantitative analysis was made on the studies with controls. The efficacy was presented as relative risk (RR), mean differences (MD), and 95% confidence intervals (CI). Results　Seventeen observation studies were included. Heterogeneity analysis was made on the studies. All the pathways included preoperative education, early oral medication, and early mobilization. Compared with peri-operative treatment, enhanced recovery after surgery pathway reduced the first and total hospitalization times (MD=-2.10, 95%CI -2.67～-1.52; MD=-3.42, 95%CI -3.96～-2.88), and did not increase the incidence of complications, case fatality rate , and re-admission rate. Conclusion　The available evidences based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery after surgery may reduce postoperative hospital stay in abdominal gynecologic surgery, so more high quality studies are needed to prove it.

Key words: Gynecologic surgery, Enhanced recovery after surgery, Perioperative management, Hospital stay

邬晓梅, 杨志娟, 郭敏, 陈娟, 侯海燕. 妇科腹部手术术后快速康复外科路径的应用效果评价与meta分析[J]. 国际医药卫生导报, 2022, 28(5): 681-686.

Wu Xiaomei, Yang Zhijuan, Guo Min, Chen Juan, Hou Haiyan. A meta-analysis and evaluation on effect of enhanced recovery after surgery pathway in abdominal gynecologic surgery[J]. International Medicine and Health Guidance News, 2022, 28(5): 681-686.

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