快速康复外科护理模式在卵巢癌患者围手术期应用效果的meta分析

A meta-analysis of perioperative efficacy of rapid rehabilitation surgical nursing model in in the perioperative period of patients with ovarian cancer

目的评价快速康复外科(ERAS)护理模式在卵巢癌患者围手术期的应用效果。方法计算机检索中国知网(CNKI)、维普(VIP)、万方数据库(WanFang Data)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Embase、Cochrane Library 8个数据库。检索自数据库建库至2020年12月发表的ERAS护理模式与常规护理模式在卵巢癌患者围手术期应用效果比较的临床试验。由两名研究者独立筛选文献,提取数据,并评估纳入研究的偏倚风险。结局指标包括30 d再入院率、术后首次进食时间、术后首次排气时间、术后首次排便时间、住院时间等,将最终纳入的文献数据整理后进行meta分析。结果共纳入12篇研究,总共1126例患者。其中,试验组553例,对照组573例。meta分析结果显示,与常规护理相比,ERAS组患者可降低30 d再入院率[OR=0.32,95%CI(0.15,0.66),P=0.002]、缩短术后首次进食时间[MD=-17.21,95%CI(-18.05,-16.37),P<0.00001]、缩短术后首次排气时间[MD=-25.27,95%CI(-40.50,-10.04),P=0.001]、缩短术后首次排便时间[MD=-19.35,95%CI(-26.84,-11.86),P<0.00001]、缩短住院时间[MD=-2.07,95%CI(-3.50,-0.64),P=0.005]。结论与常规护理模式相比,卵巢癌患者围手术期应用ERAS护理模式可降低卵巢癌患者的30 d再入院率,缩短术后进食时间及住院时间,是安全可行的护理措施,可在临床上进一步推广应用。

Objective To evaluate the application effect of rapid rehabilitation surgery(ERAS)nursing model in the perioperative period of patients with ovarian cancer.Methods Eight databases including China national knowledge infrastructure(CNKI),VIP,WanFang Data,Chinese biomedical literature database(CBM),PubMed,Web of Science,Embase and Cochrane Librarywere searched by computer.The clinical trials comparing the perioperative efficacy of ERAS versus conventional care models in ovarian cancer patients were retrieved from the database construction and published in December 2020.Two investigators independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.The outcome indicators included readmission rate at 30 days,time of first postoperative feeding,time of first postoperative exhaust,time of first postoperative defecation,length of hospital stay,etc.Meta-analysis was performed on the included literature data.Results A total of 12 studies involving 1126 patients were included.There were 553 cases in the experimental group and 573 cases in the control group.The results of meta-analysis showed that compared with routine nursing,ERAS group could reduce the 30 day readmission rate(OR=0.32,95%CI[0.15,0.66],P=0.002),shorten the time of first eating after operation(MD=-17.21,95%CI[-18.05,-16.37],P<0.00001),shorten the time of first exhaust after operation(MD=-25.27,95%CI[-40.50,-10.04],P=0.001),shorten the first defecation time(MD=-19.35,95%CI[-26.84,-11.86],P<0.00001),shorten the hospital stay(MD=-2.07,95%CI[-3.50,-0.64),P=0.005].Conclusion Compared with the conventional nursing mode,the perioperative application of ERAS nursing model for patients with ovarian cancer is a safe and feasible nursing measure,which can reduce the 30-day readmission rate,shorten the postoperative eating time and hospitalization time.