早期下床活动对心脏起搏器置入术后并发症影响的系统评价

Effects of postoperative early mobilization on pacemaker complications:a systematic review

目的评价早期下床活动对心脏起搏器术后患者并发症的影响。方法计算机检索Cochranelibrary、OVID、PubMed、中国知网数据库、维普数据库、万方数据库文献，英文数据库以“pacemaker、complication、leaddislocation／pocketbleeding／hematoma”为检索词，中文数据库以“心脏起搏器、并发症、电极脱位／电极移位／囊袋出血／囊袋血肿”为检索词，并筛选已获文献的参考文献，纳入关于心脏起搏器置入术后早期下床活动的随机对照试验（RCT）文献。由2名评价员根据CochraneHandbook5．0推荐的“偏倚风险评估”工具对纳入研究的文献独立进行方法学质量评价，采用Revman5．1．5软件进行Meta分析。结果共纳入6篇文献，合计1424例患者。Meta分析结果显示，心脏起搏器置入术后3～12h下床活动与24h后下床活动比较，电极脱位、囊袋出血的发生率差异无统计学意义（均P〉0．05），排尿困难发生率差异有统计学意义（P〈0．01）。结论心脏起搏器置入术后早期下床活动不仅没有增加电极脱位、囊袋出血的风险，而且能降低排尿困难的发生率。

Objective To systematically evaluate the effects of postoperative early mobilization on pacemaker complications. Methods We searched the Cochrane library, OVID, PubMed, CNKI, VIP, Wanfang database with the key words of pacemaker, complication, lead dislocation/pocket bleeding and hematoma for randomized controlled trials（RCTs） on postoperative early mobilization. Then two reviewers independently evaluated the quality of the included RCTs by consulting to ＂bias in risk assessment＂ from Cochrane Handbook 5.0. Then we used Revman 5.1.5 software to run meta-analysis. Results There were six papers included into the study totaling 1424 cases. Meta analysis showed that mobilization within 3 to 12 hours postoperatively causes as many cases of electrode dislocation and capsular bag bleeding as mobilization after 24 hours. However the rates of dysuria had significant difference （P〈 0.01）. Conclusion Early mobilization after pacemaker implantation doesnt t increase the incidence rates of electrode dislocation,cap- sular bag bleeding. On the other hand, the practice reduces the rates of dysuria.