加速康复外科对老年髋关节置换患者影响的Meta分析

Meta-analysis of the effect of enhanced recovery after surgery on elderly patients with hip replacement

目的系统评价加速康复外科对老年髋关节置换患者的效果。方法计算机检索万方(Wanfang)、维普(VIP)、知网(CNKI)、中国生物医学文献数据库(CBM)、Pubmed、Cochrane Library、Embase等数据库中有关加速康复外科对老年髋关节置换患者影响的随机对照试验,检索时限于建库至2022年2月。本研究选用RevMan5.3对结局指标进行Meta分析。结果本研究纳入10篇原始研究,共1367位研究对象。Meta分析结果显示,与传统护理相比,加速康复外科能显著提高老年髋关节置换术后3个月的髋关节功能(Harris)评分[MD=5.09,95%CI(4.04,6.15),P<0.00001],减少并发症的发生[MD=0.33,95%CI(0.23,0.49),P<0.00001],缩短住院时长[MD=-3.45,95%CI-(4.70,-2.20),P<0.00001]。结论与传统护理相比,加速康复外科更能够提高老年髋关节置换术后3个月的Harris评分,减少并发症的发生和缩短住院时长。但纳入的文献质量不高以及实施加速康复外科和传统护理的措施不完全一致,需更多高质量研究进一步验证。

Objective To systematic evaluation of the effect of enhanced recovery after surgery on elderly patients with hip replacement.Methods Randomized controlled trials on the effects of enhanced recovery after surgery on elderly patients with hip replacement were searched in Pubmed,Cochrane Library,Embase,Wanfang,VIP,CNKI and CBM by computer,and the retrieval time was from the establishment of database to February 2022.In this study,RevMan5.3 was used for meta-analysis of outcome indicators.Results This study included 10 original studies with a total of 1367 subjects.The meta-analysis showed that enhanced recovery after surgery significantly improved hip function scores at 3 months after hip replacement in elderly patients compared with traditional care[MD=5.09,95%CI(4.04,6.15),P<0.00001],reduce the incidence of complications[MD=0.33,95%CI(0.23,0.49),P<0.00001],reduced length of hospital stay[MD=-3.45,95%CI(4.70,-2.20),P<0.00001].Conclusion Compared with traditional care,enhanced recovery after surgery can improve the Harris score at 3 months after hip replacement in the elderly,reduce complications and shorten the length of hospital stay.However,the quality of the included literature is not high and the implementation of accelerated rehabilitation surgery and traditional nursing measures are not completely consistent,which requires further verification by more high-quality studies.