加速康复外科在肾移植受者围术期应用效果的Meta分析

Effect of Enhanced Recovery after Surgery in Kidney Transplantation Recipients during Perioperative Period:a Meta-Analysis

目的:系统评价在肾移植受者围术期开展加速康复外科(ERAS)的应用效果。方法:计算机检索CNKI、万方、维普、The Cochrane Library、Pub Med等数据库,搜集有关加速康复外科在肾移植受者围术期中应用的随机对照试验(RCTs)或非随机对照试验(NRCTs),由两名研究者独立筛选文献、提取资料并进行方法学质量评价后,采用R 4.0.0软件进行Meta分析。结果:共纳入8个RCTs和6个NRCTs,包括2 125例患者。Meta分析结果显示,与对照组相比,加速康复外科组缩短了住院天数[MD=-3.25,95%CI (-3.97,-2.52),P<0.000 1]、首次下床时间[MD=-1.93, 95%CI (-2.20,-1.65),P<0.000 1]、首次排便时间[MD=-1.70, 95%CI (-3.02,-0.37),P=0.012];而术后出血[RR=0.48, 95%CI (0.22, 1.03),P=0.06]、肺部感染[RR=0.64, 95%CI (0.35, 1.16),P=0.14]、深静脉血栓[RR=0.28, 95%CI (0.06, 1.34),P=0.11]发生率两组间差异无统计学意义。结论:加速康复外科可以缩短肾移植受者住院时间、首次下床时间、首次排便时间,不增加术后出血风险。

Objective: To systematically evaluate the efficacy of enhanced recovery after surgery(ERAS) for kidney transplantation recipients during perioperative period. Methods: Databases including CNKI, Wan Fang Data, VIP, The Cochrane Library and Pub Med were electronically searched to collect the randomized controlled trials(RCTs) or non-randomized controlled trials(NRCTs) on the effect of ERAS for renal transplant recipients. The literature was screened by two researchers independently. The data were extracted and bias risks of included studies were evaluated. The R 4.0.0 software was used to perform the metaanalysis. Results: There were 8 RCTs and 6 NRCTs included, involving 2 125 patients. The results of metaanalysis suggested that the hospital stay [MD=-3.25, 95%CI(-3.97,-2.52), P<0.000 1], the first time out of bed [MD=-1.93, 95%CI(-2.20,-1.65), P<0.000 1] and the first defecation time [MD=-1.70, 95%CI(-3.02,-0.37), P=0.012] were significantly reduced in ERAS group when compared with the control group. While the risk of postoperative bleeding [RR=0.48, 95%CI(0.22, 1.03), P=0.06], pulmonary infection [RR=0.64, 95%CI(0.35, 1.16), P=0.14] and deep venous thrombosis [RR=0.28, 95%CI(0.06, 1.34), P=0.11] had no significant differences between the two groups. Conclusion: ERAS could shorten the hospital stay, first time out of bed, and first defecation time for kidney transplant recipients, without increasing the risk of postoperative bleeding.