快速康复外科在胆道结石患者围手术期护理中安全性和有效性的Meta分析

Safety and efficacy of fast-track surgery in perioperative nursing for biliary calculi surgery: a meta-analysis

目的系统评价快速康复外科(FTS)在胆道结石手术围手术期护理中的有效性和安全性。方法系统检索Pubmed、Cochrane library、中国生物医学文献数据库(CBM)、中国知网、维普和万方数据库中的随机对照试验(RCT)。采用Cochrane工具评估文献风险,数据分析使用Rev Man 5.3软件。各研究间的统计学异质性采用χ2检验。结果纳入11项RCT,共计1455例患者(FTS组738例,对照组717例)。Meta分析结果显示:FTS组显著缩短了术后住院时间[均数差(MD)=-4.10,95%可信区间(95%CI):-5.68^-2.52,P<0.000 01)],减少了住院费用(MD=-0.47,95%CI:-0.60^-0.34,P<0.000 01);加快了胃肠恢复时间[标准均数差(SMD)=-2.05,95%CI:-2.84^-1.27,P<0.000 01)],并缩短了首次排便时间(SMD=-1.27,95%CI:-2.08^-0.46,P<0.000 01)。安全性方面,FTS显著降低了胆管结石[风险比(RR)=0.53,95%CI:0.43~0.65,P<0.000 01]和肝胆管结石(RR=0.52,95%CI:0.35~0.77,P=0.001)的总并发症。结论 FTS应用于胆道结石手术围手术期护理是安全有效的,可显著减少术后住院时间、加快胃肠恢复和缩短首次排便时间,同时降低了术后总并发症。

Objective To systematically review the efficacy and safety of fast- track surgery（ FTS） in perioperative nursing for biliary calculi surgery. Methods Online databases of Pub Med,Cochrane Library,CBM,CNKI,VIP,and Wanfang Data were comprehensively searched for relevant randomized controlled trials（ RCTs）. Potential bias was evaluated by Cochrane tools and data were analyzed by RevMan 5. 3. Results A total of 11 RCTs with 1455 patients were included（ 738 cases in FTS group and 717 cases in control group）. The results of meta- analysis showed that FTS significantly reduced the length of postoperative hospital stay（ MD =- 4. 10,95% CI：- 5. 68 to- 2. 52,P〈0. 000 01） and hospital costs（ MD =- 0. 47,95% CI：- 0. 60 to- 0. 34,P〈0. 000 01）; meanwhile,FTS shortened the time to gastrointestinal recovery（ SMD =- 2. 05,95% CI：- 2. 84 to- 1. 27,P〈0. 000 01）,as well as the time to first defecation（ SMD =- 1. 27,95% CI：- 2. 08 to- 0. 46,P〈0. 000 01）. As for safety,FTS significantly reduced the total complications of choledocholithiasis（ RR = 0. 53,95% CI： 0. 43- 0. 65,P〈0. 000 01） and hepatolithiasis（ RR = 0. 52,95% CI： 0. 35- 0. 77,P = 0. 001）. Conclusion FTS is effective and safe in perioperative nursing for biliary calculi surgery. It can significantly reduce the length of postoperative hospital stay,enhance gastrointestinal recovery,shorten the time to first defecation,and reduce total complications.