术后早期活动对腹部手术病人快速康复影响的Meta分析

Impact of early postoperative activities on rapid recovery of patients undergoing abdominal surgery:a Meta-analysis

[目的]评价术后早期活动对腹部手术病人术后快速康复进程的影响。[方法]利用计算机检索万方、CNKI、维普、PubMed、the Cochrane Library、EMbase、Sciencedirect数据库建库至2018年8月31日发表的有关腹部手术病人术后采取早期活动的随机对照试验、病例对照试验。由2名研究者分别对符合纳入标准的研究进行质量评价和数据提取,采用RevMan 5.3.5对术后结局指标进行Meta分析。[结果]共纳入10项随机对照试验,纳入分析的971例病人中实验组(术后早期活动采取精细化护理流程)485例,对照组(术后早期活动采取传统护理流程)486例。与对照组相比,实验组术后首次排气时间较短[WMD=-13.10,95%CI(-19.88,-6.32),P<0.05],术后首次排便时间较短[WMD=-14.23,95%CI(-22.15,-6.31),P<0.05],术后第1天疼痛评分较低[WMD=-0.41,95%CI(-0.56,-0.26),P<0.05],术后第1天睡眠时间较多[WMD=0.87,95%CI(0.58,1.16),P<0.05],术后第2天睡眠时间较多[WMD=1.08,95%CI(0.85,1.32),P<0.05],术后第3天睡眠时间较多[WMD=0.96,95%CI(0.76,1.16),P<0.05],术后胃肠道不适发生率较低[OR=0.24,95%CI(0.14,0.41),P<0.05]。[结论]现有证据表明,术后早期活动的精细化护理能够有效促进腹部手术病人的胃肠功能恢复,缓解疼痛,改善睡眠质量,促进病人快速康复。

Objective:To evaluate the impact of early postoperative activities on rapid recovery in patients undergoing abdominal surgery.Methods:Randomized controlled trials(RCTs)and case-control studies describing the early postoperative activities in patients undergoing abdominal surgery,were retrieved from following databases.Wanfang Database,China National Knowledge Infrastructure(CNKI),VIP Database,PubMed,Cochrane Library,Embase,and Sciencedirect.The retrival time was from the establishment of the database to 31 August 2018.The quality evaluation and data extraction for the studies that met the inclusion criteria,were conducted by two researchers independently.And a Meta-analysis on the postoperative indicators was performed using RevMan 5.3.5 software.Results:A total of 10 RCTs were included in this paper,involving 971 patients.The experimental group(n=485)received the early postoperative activities by refined nursing programs.And the control group(n=486)received the early postoperative activities by traditional nursing programs.Compared with the control group,the first postoperative exhaust time in the experimental group was shorter than that of control group[WMD=-13.10,95%CI(-19.88,-6.32),P<0.05].The first postoperative defecation time in the experimental group was shorter than that of control group[WMD=-14.23,95%CI(-22.15,-6.31),P<0.05].And the score of pain on the first day after surgery in the experimental group was lower than that of control group[WMD=-0.41,95%CI(-0.56,-0.26),P<0.05].Sleep time on the first day after surgery in the experimental group was longer than that of control group[WMD=0.87,95%CI(0.58,1.16),P<0.05].Sleep time on the second day after surgery in the experimental group was longer than that of control group[WMD=1.08,95%CI(0.85,1.32),P<0.05].Sleep time on the third day after surgery in the experimental group was longer than that of control group[WMD=0.96,95%CI(0.76,1.16),P<0.05].The incidence of postoperative gastrointestinal discomfort in the experimental group was lower than that of control group[OR=0.24,95%CI(0.14,0.41),P<0.05].Conclusions:Existing research showed that refined nursing of early postoperative activities could effectively promote the recovery of gastrointestinal function in patients un dergoing abdominal surgery,relieve the pain,after surgery quality of sleep,and enhance rapid recovery of patients.