快速康复外科在剖宫产围术期临床应用的Meta分析

Meta-analysis of clinical application of rapid rehabilitation surgery in caesarean section

目的 评价快速康复外科（fast track surgery,FTS）在剖宫产围术期临床应用的安全性及有效性.方法 计算机检索PubMed、Web of Scince、Embas、Cochrane Library、CBM、CNKI、万方数据库,并辅以手工检索,检索时间均从建库开始截止至2016年4月,收集有关FTS在剖宫产围术期应用的随机对照实验（RCT）,同时筛检纳入文献的参考文献.按纳入排除标准选择文献,由两人独立进行RCT的筛选、资料提取,根据Cochrane系统评价手册5.2.0评价纳入研究质量后,进行Meta分析.结果 最终纳入13项RCT,共3 002例患者;质量评价结果显示：13项研究为中等质量研究.Meta分析结果显示：FTS组相比传统组,术后首次排气时间缩短,下床活动时间提前,初始泌乳时间提前,72 h泌乳量增多,产后6 h子宫底高度降低,切口愈合时间缩短,住院时间缩短,住院费用减少,泌尿系统感染、寒战、呕吐、疼痛等术后并发症发生率均降低（均P〈0.05）.结论 在剖宫产围术期应用快速康复外科技术是安全的,并且能缩短住院时间,减少术后并发症,加速产妇康复.

Objective To systematically assess the safety and efficacy of using fast track surgery （FTS） technique in the setting of caesarean section. Methods The following electronic databases as PubMed, EMBASE, the Cochrane Library, CBM and CNKI were retrieved on computer from their establishment to April 2016 to search for randomized controlled trials （RCT） about FTS in the setting of caesarean section, and screen the document literature brought into the article. The methodological quality of the included RCT was assessed by two reviewers independently. After studying the quality according to the scale of criteria for methodological quality Cochrane Reviewer Handbook 5.0. 2, the meta-analysis was conducted. Results A total of 13 RCT involving 3 002 patients were included, and all of them quality were medium. The meta-analysis showed that FTS group compared with the traditional group, the time to first postoperative flatus and off-bed activity, as well as the initial lactation time were significant shorter. The quantity of 72 hours lactation increased. The bottom of the uterus after postpartum highly reduced. The healing time of incision shortened. The hospitalization time and cost were significant reduced. The postoperative morbidity were decreased （P〈 0. 05） . Conclusions Use of FTS in the setting of caesarean section is safe and effective, and it can also reduce the length of hospital stay and incidence of postoperative complications, and thereby accelerate postoperative recovery of the patients.