加速康复外科理念在老年髋部骨折患者围手术期中应用效果的Meta分析

The effect of perioperative application of enhance recovery after surgery for elderly patients with hip fracture:A Meta-analysis

目的系统评价加速康复外科(ERAS)在老年髋部骨折患者围手术期中的应用效果。方法检索中国知网、中国生物医学数据库、万方数据库、维普引文数据库以及PubMed、Web Of Science、EMBASE、Cochrane Library数据库,收集从建库到2020年5月关于ERAS在老年髋部骨折患者围手术期中应用效果的随机对照试验。使用RevMan 5.3软件进行统计分析,计算各效应量及其95%可行区间(CI)。结果共纳入18篇文献,总样本数为1568例。Meta分析结果显示:运用加速康复外科,可降低疼痛视觉模拟(VAS)评分[WMD=-0.73,95%CI(-0.95,-0.51),P<0.00001],提高Harris髋关节功能评分[WMD=4.28,95%CI(2.10,6.45),P=0.0001],缩短首次下床活动时间[WMD=-1.33,95%CI(-1.73,-0.93),P<0.00001],缩短住院天数[WMD=-3.15,95%CI(-3.79,-2.50),P<0.00001],降低住院费用[WMD=-0.47,95%CI(-0.54,-0.41),P<0.00001],降低整体并发症发生率[OR=0.37,95%CI(0.26,0.53),P<0.00001]。结论ERAS理念下的治疗和护理模式能提高髋部骨折患者术后髋关节康复效果,减轻疼痛,缩短首次下床活动时间和住院时间,降低肺部感染、泌尿系统感染和深静脉血栓(DVT)的发病率。

Objective To systematically evaluate the effect of enhance recovery after surgery(ERAS)during the perioperative period for elderly patients with hip fracture.Methods The Chi⁃na National knowledge Infrastructure,China Biomedical Database,Wanfang database,VIP cita⁃tion database and PubMed,Web of Science,EMBASE,Cochrane Library database were re⁃trieved.Randomized controlled trials of ERAS in elderly hip fracture patients were collected from the establishment of the database to June 2019 at home and abroad.RevMan 5.3 software was used for statistical analysis,and the effects and their 95%confidence interval(CI)were calculat⁃ed.Results A total of 1336 samples from 16 literatures were included.The results of Meta-anal⁃ysis showed that with the application of enhance recovery after surgery could reduce the visual pain simulation score of VAS[WMD=-0.73,95%CI(-0.95,-0.51),P<0.00001],improve the Harris hip joint score[WMD=4.28,95%CI(2.10,6.45),P=0.0001],advance the first time of getting out of bed[WMD=-1.33,95%CI(-1.73,-0.93),P<0.00001],shorten the days of hos⁃pitalization[WMD=-3.15,95%CI(-3.79,-2.50),P<0.00001],decrease the average hospital⁃ization cost[WMD=-0.47,95%CI(-0.54,-0.41),P<0.00001],and reduce the incidence of complications[OR=0.26,95%CI(0.26,0.53),P<0.00001].Conclusion The treatment and nursing mode under the concept of accelerated rehabilitation surgery can improve the rehabilitation effect of hip joint after hip fracture,reduce pain,shorten the time of getting out of bed and hospi⁃talization for the first time,and reduce the incidence of pulmonary infection,urinary tract infec⁃tion and deep vein thrombosis(DVT).