腹部手术患者应用生长激素的随机对照研究的系统评价

Growth Hormone for Patients Undergoing Abdominal Surgery:a Systematic Review of Randomized Controlled Trials

目的评价腹部手术患者围手术期应用生长激素的安全性和有效性。方法检索中国生物医学文摘数据库(CBM)、MEDLINE、EMBASE和Cochrane图书馆,收集所有相关随机对照试验,对其逐个进行质量评价,并进行Meta-分析。结果纳入18个随机对照试验,共治疗646例患者。分析结果表明,腹部手术患者围手术期应用生长激素:(1)有助于纠正负氮平衡:共有11个试验233例患者,合并后的标化均数差值(standardizedmeandifferenceSMD)为3.3795%CI2.464.27P<0.00001;(2)有助于缩短住院时间:共有3个试验218例患者,合并后的加权均数差值(weightedmeandifferenceWMD)为-2.0795%CI-3.03-1.11P<0.00001;(3)有助于减轻术后疲劳综合征的程度:共有3个试验84例患者,合并后的SMD为-1.8395%CI-2.37-1.30P<0.00001;(4)引起血糖升高:共有6个试验265例患者,合并后的WMD为0.9195%CI0.561.25P<0.00001。结论在无禁忌证的腹部手术患者围手术期应用生长激素是安全有效的,但应关注血糖的变化。进行更多、大样本、高质量的随机对照试验仍有必要。

Objectives To assess the effectiveness and safety of perioperative growth hormone(GH)treatment for patients undergoing abdominal surgery. Methods Search was applied to the following electronic databases: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, Chinese Bio-medicine Database. The search was undertaken in February, 2003. No language restrictions were applied. Randomized controlled trials(RCT)compared GH with placebo in patients undergoing abdominal surgery. The two reviewers reached consensus for inclusion of trials. Data were extracted and evaluated by the two reviewers independently of each other. The methodological quality of trials was evaluated using the Jadad scale. Results Eighteen trials involving 646 patients were included. The combined results showed that GH had positive effect on improving postoperative nitrogen balance(standardized mean difference = 3.37, 95%CI[2.46, 4.27], P < 0.00001), and decreasing length of hospital stay(weighted mean difference= -2.07, 95%CI[-3.03, -1.11], P < 0.00001), and reducing the duration of the postoperative fatigue syndrome(SMD = -1.83, 95%CI[-2.37, -1.30], P < 0.00001), but it can increase blood glucose levels(WMD = 0.91, 95%CI[0.56, 1.25], P < 0.00001). Conclusions GH for patients undergoing abdominal surgery is effective and safe if blood glucose can be controlled well. Further trials are required with sufficient size to account for clinical heterogeneity and to measure other important outcomes, such as infection, morbidity, mortality, fluid retention, immunomodulatory effects, tumor recurrence.