快速康复护理对胃肠手术患者术后恢复系统评价及GRADE分析

Systemic evaluation and grade analysis of rapid rehabilitation nursing for postoperative recovery in patients with gastrointestinal surgery

目的评价快速康复护理对胃肠手术患者术后恢复及并发症的影响。方法计算机检索Cochrane Library、MEDLINE、EMBASE(Ovid)、中国生物医学数据库(CBM)、中国期刊全文数据库(CNKI)及中国科技期刊全文数据库(VIP),截止时间到2016年12月1日。两名研究者独立地进行文献阅读删选,数据提取及文献质量评价。对符合纳入标准的文献采用Rev Man5.1进行统计分析,在结果解释及得出结论过程中利用分级的评估、制定与评估(Grades of Recommendations Assessment,Development and Evaluation,GRADE)方法进行证据质量的评价。结果 7篇文献共包含792个胃肠手术患者符合纳入标准,Meta分析结果显示快速康复护理优于常规胃肠外科围手术期护理,具体体现为观察组术后恢复流质饮食时间(SMD=-1.51,95%CI:-1.70^-1.31),肛门排气时间(SMD=-0.69,95%CI:-0.96^-0.42),及住院时间均比对照组短(SMD=-1.16,95%CI:-1.32^-1.00),且观察组不良事件发生率低于对照组(OR=0.44,95%CI:0.32~0.61)。依据GRADE分析结果,该证据质量为中等证据。结论对胃肠手术患者进行快速康复护理优于常规护理。

Objective To evaluate the effect of rapid rehabilitation nursing on postoperative recovery and complications of pa- tients after gastrointestinal surgery. Methods Cochrane Library, MEDLINE, Embase （ ovid ）, Chinese biomedical database （ CBM ）, Chinese journal full-text database （CNKI）, full-text database of Chinese sci-tech journals （VIP） were searched until December 1, 2016. Two researchers independently conducted literature reading Co-option, data extraction, and literature quality evaluation. Through the statistical analysis of the literatures in accordance with the inclusion criteria, the quality of evidence was evaluated by the grade method in interpretation and conclusion of the results. Results Seven literatures including 792 patients after gastrointestinal surgery were complied with the inclusion criteria. Meta analysis showed that the rapid rehabilitation nursing was better than routine perioperative nursing care of gastrointestinal surgery. Concrete embodiments were that recovery time of liquid diet （SMD =- 1.51,95% CI：-1.70 ~1.31 ）, time of passage of gas by anus （SMD =-0. 69,95% CI：-0. 96^-0. 42 ） , and hospitalization time （SMD =- 1.16,95% CI：- 1.32 ^-1.00） in the observation groups were shorter,and the incidence of adverse events was lower than those in the control groups （or = 0.44,95%CI：0.32 ~0. 61）. According to the results of grade analysis,the quality of the evidence was medium. Conclusion The rapid rehabilitation nursing for patients with gastrointestinal operation is better than routine nursing.