术中体温保护对老年关节置换术患者术后出血影响的Meta分析

Meta-analysis of influence of intraoperative temperature protection on postop-erative bleeding in elderly patients undergoing joint replacement surgery

目的采用Meta分析探讨术中体温保护对老年关节置换术患者术后出血的影响。方法采用Cochrane系统评价方法,计算机检索PubMed、EMbase、Cochrane图书馆、中国知网(CNKI)、中国生物医学网(CBM)、万方数据库(WanFang Data)。检索2000年1月—2021年7月的文献,收集关于术中体温保护对老年关节置换术患者术后出血的临床随机对照试验(RCT)。按Cochrane系统评价方法,对提取的有效数据采用RevMan5.3软件进行Meta分析。结果纳入8项研究,共计951例患者,其中术中采取积极保温的患者476例,术中采取常规保温的患者475例。Meta分析结果显示:术中采取积极的体温保护策略较常规体温保护的患者术中的出血量显著减少(MD值为:−46.57,95%CI:−76.23—−16.91,I^(2)=94%,P<0.002)、输血需求的患者也显著减少(OR值为:−0.45,95%CI:0.25—0.82,I^(2)=10%,P=0.009);采取积极体温保护的患者术中和术后的体温均高于常规体温保护的患者,差异有统计学意义(MD值为:0.37,95%CI:0.30—0.45,I^(2)=0%,P=0.00001;MD值为:0.66,95%CI:0.12—1.21,I^(2)=97%,P=0.02);但手术切口感染和住院时间差异无统计学意义。结论实施关节置换手术的老年患者术中采取积极体温保护可显著减少术中出血量和需要输血的比例,并可改善老年患者的预后。

Objective To explore the influence of intraoperative body temperature protection on postoperative bleeding in elderly patients undergoing joint replacement surgery by using Meta-analysis method.Methods The Cochrane system evaluation method were used to retrieve the literature of PubMed,EMbase,Cochrane Library,China Knowledge Network(CNKI),China Biomedical Network(CBM),and WanFang Database from January 2000 to July 2021,and clinical randomized controlled trials(RCT)on intraoperative temperature protection for postoperative bleeding in elderly patients undergoing joint replacement surgery were collected,and the extracted valid data was analyzed by RevMan5.3 software.Results A total of 951 patients were enrolled in 8 studies,including 476 patients with active thermal insulation during the operation and 475 patients with routine thermal insulation during the operation.The meta-analysis results showed that the intraoperative blood loss of patients with active temperature protection strategy was significantly reduced compared with conventional temperature protection(MD value:-46.57,95%CI:[-76.23,-16.91],I^(2)=94%,P<0.002),the number of patients requiring blood transfusion was also significantly reduced(OR value:-0.45,95%CI:[0.25,0.82],I^(2)=10%,P=0.009);the body temperature of patients taking active body temperature protection during and after surgery were all higher than those of conventional body temperature protection(MD value:0.37,95%CI:[0.30,0.45],I^(2)=0%,P=0.00001;MD value:0.66,95%CI:[0.12,1.21],I^(2)=97%,P=0.02);but there was no statistical difference in surgical wound infection and hospital stay.Conclusion Active body temperature protection in the elderly patients undergoing joint replacement surgery can significantly reduce the intraoperative blood loss and the proportion of blood transfusions requirement,and improve the prognosis of the elderly patients.