术中目标导向液体治疗对老年胃肠道手术患者术后恢复影响的Meta分析

Effects of intraoperative goal-directed fluid therapy on the outcome of elderly patients undergoing gastrointestinal surgery: A Meta-analysis

目的系统评价术中目标导向液体治疗(goal directed fluid therapy, GDFT)对老年胃肠道手术患者术后恢复的影响。方法网络检索PubMed、Embase、the Cochrane Library、中国知网、万方数据库、CBM数据库中关于GDFT对老年胃肠道手术患者术后恢复的随机对照试验(randomized controlled trial, RCT),检索时间自2010年1月至2020年9月:治疗组采用GDFT,对照组采用常规液体治疗,主要指标为术后住院时间、肺部并发症、心血管系统并发症、恶心呕吐、术后3 d术后认知功能障碍(postoperative cognitive dysfunction, POCD)发生率和首次排气时间,次要指标为术后血清乳酸含量。本研究采用Revman 5.3软件进行Meta分析。结果纳入15个RCT,共计1 146例患者。相比于对照组,治疗组患者术后住院时间缩短[均数差(mean difference, MD)=-3.22,95%CI -4.50~-1.93,P<0.01],术后肺部并发症减少(MD=0.22,95%CI 0.12~0.40,P<0.01),心血管系统并发症减少(MD=0.29,95%CI 0.14~0.61,P<0.01),恶心呕吐发生率降低(MD=0.37,95%CI 0.17~0.80,P<0.05),术后3 d POCD发生减少(MD=0.37,95%CI 0.22~0.62,P<0.01),首次排气时间缩短(GDFT组:MD=-15.09,95%CI -17.94~-12.23,P<0.01;GDFT联合预防性缩血管药物组:MD=-14.00,95%CI -24.64~-3.36,P<0.05),术后血清乳酸含量减少(GDFT组:MD=-0.40,95%CI -0.49~-0.31,P<0.01;GDFT联合预防性缩血管药物组:MD=-0.70,95%CI -0.90~-0.50,P<0.05)。结论术中GDFT有助于老年胃肠道手术患者氧供需平衡,且减少术后心血管系统和肺部并发症,降低术后恶心呕吐和术后3 d POCD发生率,缩短术后住院时间,有利于术后恢复。

Objective To systematically review the effects of intraoperative goal directed fluid therapy(GDFT)on the outcome of elderly patients undergoing gastrointestinal surgery.Methods PubMed,Embase,the Cochrane Library,CNKI,Wanfang and CBM were searched from January 2010 to September 2020 to screen out randomized controlled trials(RCT)concerning the effects of GDFT on the outcome of elderly patients undergoing gastrointestinal surgery.The treatment group received GDFT,while the control group was given routine fluid therapy.The major evaluation indicators included the length of postoperative hospitalization stay,pulmonary complications,cardiovascular complications,nausea and vomiting,the incidences of postoperative cognitive dysfunction(POCD)3 d after operation,first exhausting time.The secondary evaluation indicator was the content of serum lactic acid.The RevMan 5.3 software was used for Meta analysis.Results A total of 15 RCT studies with a total of 1146 patients were included,based on the inclusion and exclusion criteria.Compared with the control group,the treatment group presented shortened length of postoperative hospitalization stay[mean difference(MD)=-3.22,95%confidence interval(CI)-4.50--1.93,P<0.01],reduced postoperative pulmonary complications(MD=0.22,95%CI 0.12-0.40,P<0.01),decreased cardiac complications(MD=0.29,95%CI 0.14-0.61,P<0.01),decreased incidences of nausea and vomiting(MD=0.37,95%CI 0.17-0.80,P=0.01),reduced POCD(MD=0.37,95%CI 0.22-0.62,P<0.01),shortened time of first postoperative exhausting(GDFT group:MD=-15.09,95%CI-17.94--12.23,P<0.01;GDFT combined with prophylactic vasoconstriction drug group:MD=-14.00,95%CI-24.64--3.36,P<0.05),decreased content of postoperative serum lactic acid(GDFT group:MD=-0.40,95%CI-0.49--0.31,P<0.01;GDFT combined with prophylactic vasoconstriction drug group:MD=-0.70,95%CI-0.90--0.50,P<0.05).Conclusions Intraoperative GDFT can help elderly patients undergoing gastrointestinal surgery to balance the need and supply of oxygen,reduce the incidence of cardiovascular and pulmonary complications,postoperative nausea and vomiting,and postoperative 3-day POCD,shorten postoperative hospitalization stay,and contribute to postoperative recovery.