胃切除术后胃排空障碍危险因素的Meta分析

Risk factors for delayed gastric emptying after gastrectomy： A meta analysis

目的 探讨胃切除术后胃排空障碍的危险因素.方法 检索中国期刊全文数据库（CNKI）、中国生物医学文献数据库、万方数据库、学位论文数据库与重要会议论文数据库以及Medline数据库2003—2013年期间公开发表的有关胃切除术后胃排空障碍危险因素的文献,提取文献资料,采用RevMan5.0软件分析胃排空障碍的相关危险因素.结果 19篇文献共9976例胃切除患者纳入分析,术后胃瘫572例（5.85％）.60岁以上高龄患者（P＜0.01,OR=1.65,95％CI：1.31～2.09）、术前贫血（P=0.01,OR=1.48,95％CI：1.08～2.02）、术前存在胃肠道梗阻（P＜0.01,OR=3.72,95％CI：3.05～4.55）、毕Ⅱ式吻合（P＜0.01,OR=3.35,95％CI：2.72～4.13）、术后应用镇痛泵（P＜0.01,OR=1.74,95％CI：1.33～2.26）、围手术期血糖超过8 mmol/L（P＜0.01,OR=2.64,95％CI：2.00～3.49）、术后白蛋白水平低于30 g/L （P＜0.01,OR=2.13,95％CI：1.62～2.79）、术后出现腹腔并发症（P＜0.01,OR=2.41,95％CI：1.77～3.29）及存在不良心理反应者（P＜0.01,OR=5.94,95％CI：1.79～19.73）术后胃排空障碍发生率明显升高;而性别、手术时间、术中出血量、手术时机及根治与否则与胃排空障碍发生无关（均P＞0.05）.结论 年龄、术前存在胃肠道梗阻、消化道重建方式、术后镇痛泵的应用、围手术期血糖和白蛋白水平、术后腹腔并发症以及患者心理状态是胃切除术后胃排空障碍的可能危险因素.

Objective To explore the risk factors of delayed gastric emptying after gastrectomy.Methods Metaanalysis was performed to screen risk factors of delayed gastric emptying after gastrectomy based on 19 associated articles published from 2003 to 2013.Results Gender,operative time,blood loss during operation,surgical settings （emergency,elective surgery）,radical surgery were not significantly different between two groups for delayed gastric emptying （all P〉0.05）.Age more than or equal to 60 years [combined odds ratio （OR）=1.65,95% confidence interval （CI）：1.31-2.09,P〈 0.01],preoperative gastrointestinal obstruction （combined OR =3.72,95% CI：3.05-4.55,P〈0.01）,Billroth-Ⅱ （combined OR=3.35,95%CI：2.72-4.13,P〈0.01）,anemia （combined OR=1.48,95%CI：1.08-2.02,P=0.01）,intra-abdominal complication （combined OR=2.41,95%CI：1.77-3.29,P〈0.01）,perioperative blood glucose greater than 8 mmol/L （combined OR=2.64,95%CI：2.00-3.49,P〈0.01）,postoperative albumin levels lower than 30 g/L （combined OR=2.13,95%CI：1.62-2.79,P〈0.01）,use of analgesics pump after operation （combined OR=1.74,95%CI：1.33-2.26,P〈0.01）,having adverse psychological reactions （combined OR=5.94,95%CI：1.79-19.73,P=0.004） were risk factors affecting delayed gastric emptying.Conclusion Age more than or equal to 60,preoperative gastrointestinal obstruction,perioperative blood glucose greater than or equal to 8 mmol/L,postoperative albumin levels less than 30 g/L,Billroth-Ⅱ,anemia,intraabdominal complication,using pain pump after operation,having adverse psychological reactions are risk factors affecting delayed gastric emptying after gastrectomy.