择期髋关节置换术患者术前口服碳水化合物效果的Meta分析

Efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery: a meta-analysis

目的系统评价术前口服碳水化合物对择期髋关节置换术患者的效果。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、WanFang Data和CNKI数据库,搜集关于择期髋关节置换术患者术前口服碳水化合物效果的随机对照试验(RCT),检索时限均为建库至2017年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个RCT。Meta分析结果显示,术前口服碳水化合物组与安慰剂组在术后胰岛素敏感性[SMD=5.14,95%CI(–1.05,11.33),P=0.10]、住院时间[MD=–0.26,95%CI(–1.11,0.58),P=0.54]、并发症发生率[OR=1.46,95%CI(0.53,4.07),P=0.47]、术后血糖水平和术后胰岛素水平方面,差异均无统计学意义。结论术前口服碳水化合物并不能改善胰岛素抵抗;其对住院时间、术后血糖、胰岛素水平也无影响。受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证。

Objective To systematically review the efficacy of preoperative administration of oral carbohydrates in patients undergoing elective hip replacement surgery. Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials （RCTs） about preoperative oral carbohydrate treatment in patients undergoing elective hip arthroplasty from inception to January, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Metaanalysis was performed by using RevMan 5.3 software. Results A total of 10 RCTs were included. The results of metaanalysis showed that： compared with the placebo group, the preoperative oral carbohydrate group had no significant differences in postoperative insulin resistance （SMD=5.14, 95%CI -1.05 to 11.33, P=0.10）, length of hospital stay （MD=-0.26, 95%CI -1.11 to 0.58, P=0.54）, rate of complications （OR= 1.46, 95%CI 0.53 to 4.07, P=0.47）, postoperative glucose and insulin level. Conclusion Current evidence shows that preoperative oral carbohydrate can not mediate postoperative insulin resistance. It also does not reduce length of hospital stay, postoperative glucose and insulin level. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.