加速康复外科方案和标准治疗方案对腹部手术患者术后急性肾损伤影响的比较Meta分析

Comparison of enhanced recovery after surgery protocol and standard care in patients undergoing abdominal surgery for postoperative acute kidney injury: a meta-analysis

中文关键词: 加速康复外科  急性肾损伤  腹部手术  Meta分析

英文关键词: Enhanced recovery after surgery  Acute kidney injury  Abdominal surgery  Meta-analysis

中文摘要:

      
目的 通过Meta分析比较加速康复外科（ERAS）方案和标准治疗方案对腹部手术患者术后急性肾损伤（AKI）的影响。
方法 通过PubMed、Embase、Cochrane Library数据库和参考文献列表进行检索，识别从建库至2020年9月符合纳入标准的相关研究。采用风险比（RR）、均数差（MD）和相应的95%可信区间（CI）及随机或固定效应模型合并分析，根据合并分析结果进行异质性检验、敏感性分析和发表偏倚的检测。
结果 共纳入包含10 570例患者的15篇队列研究。与标准治疗组比较，ERAS组腹部手术后AKI发生率明显升高（RR=1.34，95%CI 1.16～1.54），住院时间明显缩短（MD=-1.53 d，95%CI -1.94～-1.13）。两组30 d再入院率（RR=0.87，95%CI 0.75～1.01）、30 d再手术率（RR=0.87，95%CI 0.60～1.27）和死亡率（RR=0.82，95%CI 0.60～1.14）差异无统计学意义。
结论 ERAS方案增加腹部手术后AKI的发生，但却没有带来相关不良预后，同时明显缩短住院时间。

英文摘要:

      
Objective To compare the effect of enhanced recovery after surgery (ERAS) protocol and standard treatment on postoperative acute kidney injury (AKI) after abdominal surgery by meta-analysis.
Methods Searches were performed in PubMed, Embase, Cochrane Library databases, and reference lists to identify relevant studies that met inclusion criteria from inception to September 2020. The risk ratio (RR), mean difference (MD) and corresponding 95% confidence interval (CI) were used to combine the analysis with random or fixed effect model. The heterogeneity test, sensitivity analysis and publication bias detection were performed according to the combined results.
Results A pooled analysis of 15 cohort studies with 10 570 patients was performed. ERAS increased the incidence of AKI after abdominal surgery (RR = 1.34, 95% CI 1.16 to 1.54), but significantly shortened the length of hospital stay (MD = -1.53 days, 95% CI -1.94 to -1.13) compared with the standard care group. There was no significant difference in 30-day readmission rate (RR = 0.87, 95% CI 0.75 to 1.01), 30-day reoperation rate (RR = 0.87, 95% CI 0.60 to 1.27) and mortality rate (RR = 0.82, 95% CI 0.60 to 1.14) between the two groups.
Conclusion The ERAS protocol increases the incidence of AKI after abdominal surgery, but it dose not have a relevant adverse prognostic effect, while significantly reducing the length of hospital stay.