快速康复外科在腰椎间盘突出症手术中临床疗效的Meta分析

Meta-analysis of Clinical Efficacy of Fast-Track Surgery in Lumbar Disc Herniation Surgery

目的:对国内外公开发表的文献中腰椎间盘突出症患者围术期应用快速康复外科理念进行康复的相关文献进行Meta分析,探讨快速康复外科在腰椎间盘突出症手术围术期中应用的临床疗效。方法:检索2006年1月1日—2017年12月31日期间中国知网(CNKI)、维普(VIP)、万方、Pubmed、Embase、Cochrane library数据库关于快速康复理念(FTS)或术后促进康复(ERAS)在腰椎间盘突出症手术中应用的相关文献,并进行Meta分析。运用改良的Jadad评分量表对随机对照实验(RCT)文献质量进行评估。纳入的数据用Review Manager 5.3软件提取分析。结果:纳入15篇文献,共计1212例患者,Meta分析结果:实验组患者整体满意度[OR=5.90,95%CI(2.94,11.86),P<0.00001]显著高于对照组,术后并发症发生率[OR=0.16,95%CI(0.06,0.48),P=0.001]明显低于对照组,疗效优良率[OR=3.0,95%CI(1.31,6.84),P=0.009]高于对照组,术前VAS评分两组差异无统计学意义(P=0.58),出院时VAS评分实验组[MD=-0.99,95%CI(-1.65,-0.34),P=0.003]低于对照组,实验组术后住院时间[MD=-2.95,95%CI(-3.66,-2.24),P<0.00001]明显少于对照组。结论:快速康复理念在腰椎间盘手术治疗中优势突出,能有效减轻围术期疼痛、减少术后并发症发生率、缩短住院时间,从而能有效提高患者生活质量,患者满意度高,值得推广。

Objective:To analyze Meta-analysis of the literature about postoperative rehabilitation of lumbar disc herniation under the guidance of fast-track surgery in the literature published at home and abroad and explore the clinical effect of fast-track concept in the treatment of lumbar disc herniation.Methods:A retrospective analysis was performed on CNKI,VIP,Wanfang,Pubmed,Embase and Cochrane database from January 2006-January 2018 for fast-track surgery(FTS)or enhanced recovery after surgery(ERAS)for recuperation Lumbar disc herniation surgery clinical application of relevant literature to make the Meta-analysis.Quality of randomized controlled trials(RCT)was assessed using a modified Jadad scale.The data in the article was extracted using Review Manager 5.3 software.Results:Only 15 pieces of literature containing 1212 cases corresponded to the inclusion criteria.The results of Meta-analysis showed that the overall satisfaction of patients in the experimental group[OR=5.90,95%CI(2.94,11.86),P<0.00001]was significantly higher than that of the control group.The complication rate[OR=0.16,95%CI(0.06,0.48),P=0.001]was significantly lower than that of the control group(OR=3.0,95%CI(1.31,6.84),P=0.009).In the control group,the preoperative VAS score had no significant difference between the two groups(P=0.58).The VAS score of the experimental group[MD=-0.99,95%CI(-1.65,-0.34),P=0.003]was lower than that of the control group.The length of stay in the control group and experimental group was significantly shorter than that of the control group[MD=-2.95,95%CI(-3.66,-2.24),P<0.00001].Conclusion:The idea of rapid rehabilitation can effectively reduce perioperative pain,the incidence of postoperative complications and shorten the hospital stay,which can effectively improve the quality of life of patients.The patients’satisfaction is worthy of promotion.