术前常规检查与选择性检查对白内障手术安全性的系统评价

Preoperative Routine Testings versus Selective Routine Testings in the Safty of Cataract Surgery:A Systematic Review

目的系统评价术前常规检查与选择性检查对白内障手术的安全性。方法按Cochrane系统评价方法,计算机检索MEDLINE(1966～2008.10)、EMbase(1980～2008.10)、Cochrane协作网眼和视力组数据库(2008年3期)、中国生物医学文献数据库(1979～2008.10),手工检索相关会议文献,纳入所有比较术前常规检查与选择性检查对白内障手术安全性的随机对照试验,并采用RevMan5.0软件进行Meta分析。结果共纳入4个随机对照试验,包括20490例患者。Meta分析结果显示,白内障手术患者,术前常规检查与选择性检查在术中全身并发症发生率[RR=1.05,95%CI(0.89,1.24),P=0.59]、术后全身并发症发生率[RR=0.97,95%CI(0.80,1.18),P=0.77]、术中眼部并发症发生率[RR=0.99,95%CI(0.74,1.33),P=0.97]及术后眼部并发症发生率[RR=1.11,95%CI(0.76,1.60),P=0.59]4方面,其差异均无统计学意义。结论术前常规检查与选择性检查相比,白内障手术患者术中、术后全身并发症发生率,以及术中、术后眼部并发症发生率差异均无统计学意义,但此结论对于危重病人的适用性有待于进一步研究。因本系统评价纳入研究较少,上述结论有待更多设计严谨的大样本随机对照试验加以验证。

Objectives To systematic review the safety of routine preoperative testings versus selective preoperative testings for cataract surgery. Methods We searched the Cochrane Central Register of Controlled Trials- Central （which contains the Cochrane Eyes and Vision Group Trials Register） in the Cochrane Library （Issue 3, 2008）, MEDLINE （1966 to Oct. 2008）, EMBASE （1980 to Oct. 2008）, CMB-disk （1979 to Oct. 2008）. We also hand-searched related journals. All the search was restricted in English and Chinese. Methodological quality of randomized controlled trials （RCTs） was evaluated by simple evaluate method that recommended by the Cochrane Collaboration. Data extracted by two reviewers with designed extraction form. RevMan 5.0 software was used for data management and analysis. Obtained evidence the safety of routine preoperative testings versus selective preoperative testings. Result Four RCTs involving 20 490 participants required cataract surgery were included by total retrieve and riddling. The result of metaanalysis showed that there was no significant difference between the two groups in the rates of intraoperative systemic events [RR=1.05, 95%CI （0.89, 1.24）, P=0.59], postoperative systemic events [RR=0.97, 95%CI （0.80, 1.18）, P=0.77], intraoperative ocular events [RR=0.99, 95%CI （0.74, 1.33）, P=0.97] and postoperative ocular events [RR=1.11, 95%CI （0.76, 1.60）, P=0.59]. Conclusion To compare routine preoperative testings group with selective preoperative testings group, there was no significant difference in the rates of intraoperative systemic events, postoperative systemic events, intraoperative ocular events and postoperative ocular events. However the application of the results to the patients with incapacitating systemic diseases needs further study.