快速康复外科在全髋关节置换手术中应用效果的Meta分析
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摘要
目的系统评价快速康复外科理念在全髋关节置换(THA)手术中的应用效果。方法检索中国知识网、万方、维普、Pubmed等数据库研究快速康复外科与传统方法在THA手术中应用效果的随机对照试验(RCT),检索时间为各数据库建库至2018-04。观察组采用快速康复外科,对照组采用传统围手术期处理。采用Rev Man 5.3软件进行文献质量评价和Meta分析。结果纳入13篇文献,共1 294例,观察组637例,对照组657例。Meta分析结果显示,快速康复外科在THA手术中应用可有效降低患者的疼痛VSA评分,提高患者髋关节功能Harris评分、日常生活能力ADL评分,缩短首次下床时间,差异有统计学意义(P <0.05)。观察组术后并发症发生率低于对照组,但差异无统计学意义(P>0.05)。敏感性分析结果显示,异质性较高的结局指标研究结果稳定可靠。结论快速康复外科在THA手术中应用安全、有效,有效促进了患者术后康复,提高了患者自理能力及生活质量。
Objective To review the application of fast track surgery in total hip arthroplasty(THA) surgery systematically.Methods The Chinese CNKI, Wanfang, Weipu, Pubmed and other databases were used to study the randomized controlled trials(RCT) of fast track surgery and traditional methods in THA surgery. The retrieval time was set up for each database up to April 2018. The observation group used fast track surgery while the control group was treated with traditional perioperative period. Literature quality evaluation and meta-analysis were performed using RevMan 5.3 software. Results A total of 1 294 cases were included in the literature, 637 in the observation group and 657 in the control group. Meta-analysis showed that the application of fast track surgery in THA surgery could effectively reduce the patient's pain VSA score, improve the hip function Harris score, daily life ability ADL score, and shorten the first time to get out of bed, the difference was statistically significant(P <0.05). The incidence of postoperative complications in the observation group was lower than that in the control group, but the difference was not statistically significant(P >0.05). Sensitivity analysis showed that the results of the heterogeneous outcome indicators were stable and reliable. Conclusion The fast track surgery is safe and effective in THA surgery, which effectively promotes postoperative rehabilitation and improves patient self-care ability and quality of life.
Objective To review the application of fast track surgery in total hip arthroplasty(THA) surgery systematically.Methods The Chinese CNKI, Wanfang, Weipu, Pubmed and other databases were used to study the randomized controlled trials(RCT) of fast track surgery and traditional methods in THA surgery. The retrieval time was set up for each database up to April 2018. The observation group used fast track surgery while the control group was treated with traditional perioperative period. Literature quality evaluation and meta-analysis were performed using RevMan 5.3 software. Results A total of 1 294 cases were included in the literature, 637 in the observation group and 657 in the control group. Meta-analysis showed that the application of fast track surgery in THA surgery could effectively reduce the patient's pain VSA score, improve the hip function Harris score, daily life ability ADL score, and shorten the first time to get out of bed, the difference was statistically significant(P <0.05). The incidence of postoperative complications in the observation group was lower than that in the control group, but the difference was not statistically significant(P >0.05). Sensitivity analysis showed that the results of the heterogeneous outcome indicators were stable and reliable. Conclusion The fast track surgery is safe and effective in THA surgery, which effectively promotes postoperative rehabilitation and improves patient self-care ability and quality of life.
引文
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[15]许硕葵,陈慧,方红霞.加速康复外科在人工全髋关节置换术的应用效果观察[J].西北国防医学杂志,2015,36(12):813-815.
[16]朱胜菊,谢玉艳.快速康复外科理念在老年人工髋关节置换术后护理中的应用[J].中国药业,2013,22(A01):149-150.
[17]霍丽娟.基于快速康复理念的护理干预对髋关节置换术后患者生活质量的影响研究[J].河北医药,2017,39(21):3348-3351.
[18] Bamgbade OA,Oluwole O,Khaw RR. Perioperative analgesia forfast-track laparoscopic bariatric surgery[J]. Obes Surg,2017,27(7):1828-1834.
[19] Hirschmann MT,Kort N,Kopf S,et al. Fast track and outpatientsurgery in total knee arthroplasty:beneficial for patients,doctorsand hospitals[J]. Knee Surg Sports Traumatol Arthrosc,2017,25(9):2657-2658.
[20] Jorgensen CC,Kehlet H.Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group. Early throm-boembolic events≤1 week after fast-track total hip and kneearthroplasty[J]. Thromb Res,2016,138(6):37-42.
[21] Van Den Eeden YN,De Turck BJ,Van Den Eeden FM. 24 hoursstay after hip replacement[J]. Acta Orthop,2017,88(1):24-28.
[22] Ahmed EA,Montalti R,Nicolini D,et al. Fast track program in liv-er resection:a PRISMA-compliant systematic review and meta-analysis[J]. Medicine(Baltimore),2016,95(28):e4154.
[23] Pike TW,Lodge JP. Fast-track management after laparoscopicroux-en-y gastric bypass[J]. J Am Coll Surg,2016,223(1):203.
[24] Ahmad S,Yilmaz M,Marcus RJ,et al. Impact of bispectral indexmonitoring on fast tracking of gynecologic patients undergoing la-paroscopic surgery[J]. Anesthesiology,2003,98(4):849-852.
[25] Llorente C,Schnabl B. Fast-track clearance of bacteria from theliver[J]. Cell Host Microbe,2016,20(1):1-2.
[26] Grant MC,Yang D,Wu CL,et al. Impact of enhanced recovery aftersurgery and fast track surgery pathways on healthcare-associatedinfections:results from a systematic review and Meta-analysis[J].Ann Surg,2017,265(1):68-79.
[27] Suominen PK,Haney MF. Fast-tracking and extubation in paedi-atric cardiac surgery[J]. Acta Anaesthesiol Scand,2017,61(8):876-879.
[28] Campbell JN,Meyer RA. Mechanisms of neuropathic pain[J]. Neu-ron,2006,52(1):77-92.
[29] Simonelli V,Goergen M,Orlando GG,et al. Fast-track in bariatricand metabolic surgery:feasibility and cost analysis through amatched-cohort study in a single centre[J]. Obes Surg,2016,26(8):1970-1978.
[30]曾智敏,凌晶,陶崑,等.快速康复理念指导人工髋关节置换术治疗老年股骨颈骨折的早期疗效分析[J].中国骨与关节损伤杂志,2018,33(5):536-537.
[2] Stowers MD,Manuopangai L,Hill AG,et al. Enhanced recovery aftersurgery in elective hip and knee arthroplasty reduces length of hos-pital stay[J]. ANZ J Surg,2016,86(6):475-479.
[3] Kehlet H. Multimodal approach to control postoperative pathophysi-ology and rehabilitation[J]. Br J Anaesth,1997,78(5):606-617.
[4] Lassen K,Coolsen MM,Slim K,et al. Guidelines for perioperativecare for pancreaticoduodenectomy:enhanced recovery after surgery(ERAS)society recommendations[J]. World J Surg,2013,31(6):817-830.
[5] Yang G,Chen W,Chen W,et al. Feasibility and safety of 2-day dis-charge after fast-track total hip arthroplasty:a chinese experience[J]. J Arthroplasty,2016,31(8):1686-1692.
[6] Hourtal J,Reina N,Gracia G,et al. Implementation of fast-tracksurgery program in total hip arthroplasty[J]. Rev De Chir Orthop EtTrauma,2016,102(7):S89-S90.
[7]袁凌.快速康复护理在髋关节置换术患者术后康复中的应用[J].国际护理学杂志,2017,36(23):3243-3245.
[8]王宇,张攀,韩文锋,等.快速康复理念在髋关节置换围手术期中的应用[J].实用骨科杂志,2017,23(2):110-113.
[9]白春莲,曹帆,史凌云,等.快速康复外科理念在人工髋关节置换术中的应用[J].海南医学,2018,29(4):584-586.
[10]李锦玲,李胜玲.快速康复外科理念在老年全髋关节置换术后患者中的应用[J].宁夏医科大学学报,2012,34(12):1334-1336.
[11]王华,罗奇,周天健,等.加速康复外科理念在高龄人工髋关节置换围手术期的应用[J].山西医药杂志,2016,45(24):2909-2912.
[12]鲁娟,余洁静,吴苗苗,等.加速康复理念在微创髋关节置换围手术期护理中的应用[J].中国现代医生,2014,52(20):76-80.
[13]程宗燕,杨丽娜,熊晏群.基于加速康复外科策略的手术室护理干预在全髋关节置换术中的应用[J].成都医学院学报,2017,12(4):514-516.
[14]丁娓.快速康复理念在髋关节置换术围手术期护理中的运用效果[J].护理实践与研究,2017,14(24):56-58.
[15]许硕葵,陈慧,方红霞.加速康复外科在人工全髋关节置换术的应用效果观察[J].西北国防医学杂志,2015,36(12):813-815.
[16]朱胜菊,谢玉艳.快速康复外科理念在老年人工髋关节置换术后护理中的应用[J].中国药业,2013,22(A01):149-150.
[17]霍丽娟.基于快速康复理念的护理干预对髋关节置换术后患者生活质量的影响研究[J].河北医药,2017,39(21):3348-3351.
[18] Bamgbade OA,Oluwole O,Khaw RR. Perioperative analgesia forfast-track laparoscopic bariatric surgery[J]. Obes Surg,2017,27(7):1828-1834.
[19] Hirschmann MT,Kort N,Kopf S,et al. Fast track and outpatientsurgery in total knee arthroplasty:beneficial for patients,doctorsand hospitals[J]. Knee Surg Sports Traumatol Arthrosc,2017,25(9):2657-2658.
[20] Jorgensen CC,Kehlet H.Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group. Early throm-boembolic events≤1 week after fast-track total hip and kneearthroplasty[J]. Thromb Res,2016,138(6):37-42.
[21] Van Den Eeden YN,De Turck BJ,Van Den Eeden FM. 24 hoursstay after hip replacement[J]. Acta Orthop,2017,88(1):24-28.
[22] Ahmed EA,Montalti R,Nicolini D,et al. Fast track program in liv-er resection:a PRISMA-compliant systematic review and meta-analysis[J]. Medicine(Baltimore),2016,95(28):e4154.
[23] Pike TW,Lodge JP. Fast-track management after laparoscopicroux-en-y gastric bypass[J]. J Am Coll Surg,2016,223(1):203.
[24] Ahmad S,Yilmaz M,Marcus RJ,et al. Impact of bispectral indexmonitoring on fast tracking of gynecologic patients undergoing la-paroscopic surgery[J]. Anesthesiology,2003,98(4):849-852.
[25] Llorente C,Schnabl B. Fast-track clearance of bacteria from theliver[J]. Cell Host Microbe,2016,20(1):1-2.
[26] Grant MC,Yang D,Wu CL,et al. Impact of enhanced recovery aftersurgery and fast track surgery pathways on healthcare-associatedinfections:results from a systematic review and Meta-analysis[J].Ann Surg,2017,265(1):68-79.
[27] Suominen PK,Haney MF. Fast-tracking and extubation in paedi-atric cardiac surgery[J]. Acta Anaesthesiol Scand,2017,61(8):876-879.
[28] Campbell JN,Meyer RA. Mechanisms of neuropathic pain[J]. Neu-ron,2006,52(1):77-92.
[29] Simonelli V,Goergen M,Orlando GG,et al. Fast-track in bariatricand metabolic surgery:feasibility and cost analysis through amatched-cohort study in a single centre[J]. Obes Surg,2016,26(8):1970-1978.
[30]曾智敏,凌晶,陶崑,等.快速康复理念指导人工髋关节置换术治疗老年股骨颈骨折的早期疗效分析[J].中国骨与关节损伤杂志,2018,33(5):536-537.