术中限制性液体方案对开腹手术患者术后状况的Meta分析

    Effect of Intraoperative Restrictive Fluid Regimes on Outcome after Intraabdominal Surgery: A Meta-Analysis

    • 摘要: 目的 通过Meta分析评价术中限制性液体方案对开腹手术患者术后状况的影响,为开腹手术术中液体治疗和管理提供循证医学依据。 方法 检索CNKI、VIP、Wanfang Data、CBM、PubMed、EMBASE、MEDLINE OvidSP以及 Cochrane图书馆(2015年第3期)中所有以论文形式发表的有关限制性液体方案和非限制性液体方案对开腹手术患者术后影响的随机对照研究,时限均为建库至2015年6月。收集各研究中术后并发症、术后住院时间、术后排气排便时间和实验室指标(包括血红蛋白、白蛋白、尿素氮、肌酐、谷草转氨酶和谷丙转氨酶等)。计数资料采用相对危险度,计量资料采用标准化均数差,各效应量均以95%可信区间表示,运用RevMan5.2软件进行统计学分析。 结果 根据研究纳入及排除标准,共有16篇随机对照研究共计1 681例病例纳入此Meta分析。结果表明,限制性液体方案组术后并发症(相对危险度=0.67,95%可信区间0.51~0.41,P=0.003)、术后肠道首次排气时间(标准化均数差=-0.94,95%可信区间 -1.15~-0.73,P<0.000 01)、术后首次排便时间(标准化均数差=-0.92,95%可信区间-1.14~-0.70, P<0.000 01)、术后住院时间(标准化均数差=-0.82, 95%可信区间-1.23~-0.40,P=0.000 1)、术后第一天全血血红蛋白含量(标准化均数差=0.83,95%可信区间0.53~1.13,P<0.000 01)均明显优于非限制性液体方案。 结论 术中限制性液体方案有助于减少开腹手术的术后并发症,更早地恢复患者肠道功能,缩短术后住院时间并降低术后贫血的程度和发生概率,本研究结论尚需高质量、大样本的随机对照试验验证。

       

      Abstract: Objective To evaluate the outcome of patients after intraabdominal surgery with restrictive fluid regimes by the meta analysis. To provide the basis on evidence-based medicine for the fluid treatment and management in the intra-abdominal surgery. Methods Data were obtained by searches of restrictive fluid regimes versus nonrestrictive fluid regimes in intraabdominal selective surgery from CNKI、VIP、Wanfang Data、CBM、PubMed、EMBASE、MEDLINE OvidSP and The Cochrane Library (Issue 3, 2015), from inception to June 2015. It was undertaken that only randomized controlled trials (RCTs) evaluating the post-operative complications, the duration of hospital stay, time to initial passage of flatus and feces and the laboratory index(including Hb,ALB,BUN,Cr,AST and ALT, etc). Enumeration data was assessed using risk ratio(RR), measurement data was assessed using standardized mean difference (SMD), and each effect sizes were assessed using 95% confidence interval(CI). Statistical analysis was performed by RevMan5.2. Results A total of 1 681 patients in 16 RCTs. It was found that patients using restrictive fluid regimes had a lower risk of postoperative complications (RR=0.67, 95%CI 0.51~0.41, P=0.003), a shorter time to initial flatus (SMD=-0.94, 95%CI-1.15~-0.73, P<0.000 01), a shorter time to initial feces (SMD=-0.92,95%CI -1.14 ~-0.70,P<0.000 01), the duration of hospital stay (SMD=-0.82,95%CI -1.23~-0.40,P=0.000 1) and the hemoglobin in the first day after surgery(SMD=0.83,95%CI 0.53~1.13,P<0.000 01) compared with those using restrictive fluid regimes. Conclusion The present meta-analysis suggests that the restrictive fluid regimes are helpful to improve the outcome after intra-abdominal surgery and the patients’ health. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.

       

    /

    返回文章
    返回