加速康复外科(ERAS)在全髋关节置换术中的安全性及有效性:meta分析

Safety and effectiveness of enhanced recovery after surgery(ERAS) in total hip arthroplasty: a meta-analysis

背景:全髋关节置换术(THA)是目前治疗髋关节重度骨关节炎的主要方式。为进一步提高术后疗效,近年来加速康复外科(ERAS)已在全髋关节置换术中得到普遍应用,但尚无对ERAS安全性及有效性的系统评价。目的:系统评价ERAS在THA中的安全性及有效性。方法:检索Pubmed、OVID、Embase、Cochrane Library、Medline、Science Direct、Wiley online library、中国知网、万方、维普等数据库中有关ERAS在THA中应用的随机对照试验(RCT)。采用Cochrane工具评估文献风险,数据分析使用RevMan 5.3软件。结果:共纳入6篇RCT,2086例患者,其中ERAS组691例,对照组1395例。Meta分析结果显示:与对照组相比较,ERAS组可显著缩短住院时间(MD=-2.55,95%CI:-2.82^-1.28,P<0.0001);ERAS组术后输血率为7.9%,显著低于对照组(RR=0.51,95%CI:0.34~0.77,P=0.001);而在术后并发症及术后恶心方面,ERAS组和对照组无明显统计学差异(P>0.05)。结论:ERAS在THA中的应用是安全有效的,可缩短住院时间、较少输血事件,但并未增加术后并发症,值得临床广泛推广。

Background:Total hip arthroplasty(THA)is the main surgical procedure of severe osteoarthritis of the hip.For improving postoperative efficacy,enhanced recovery after surgery(ERAS)has been widely used in THA in recent years.However,there is no systematic review on the safety and effectiveness of ERAS.Objective:To evaluate the safety and effectiveness of ERAS in THA.Methods:Randomized controlled trials(RCTs)on ERAS performed in THA were searched in recognized databases,such as Pubmed,OVID,Embase,Cochrane Library,Medline,Science Direct,Wiley online library,CNKI,Wanfang and VIP databases.The Cochrane collaboration’s tool was used for assessing risk of bias.RevMan 5.3 software was used for metaanalysis.Results:A total of 6 RCTs were included in this study,with a total of 2086 patients,of which 691 were in ERAS group and 1395 in control group.The length of stay(LOS)in the ERAS group was significantly less than that in the control group(MD=-2.55;95%CI:-2.82,-1.28;P<0.0001).Postoperative transfusion rate of ERAS group was 7.9%,which was significantly lower than that in the control group(RR=0.51;95%CI:0.34,0.77;P=0.001).There were no significant differences between the two groups in postoperative complications or nausea(P>0.05).Conclusions:ERAS in THA is safe and effective.It can reduce LOS and transfusion,and it is worthy of wide clinical application.