摘要
目的系统评价加速康复外科(enhanced recovery after surgery,ERAS)理念在小儿急性阑尾炎手术治疗中的应用疗效。方法参考Cochrane协作网制定的检索策略,采用主题词和自由词相结合的方式分别在中国知网、万方医学网、PubMed、EBSCO、Medline及Cochrane数据库中进行检索。其中,英文检索关键词包括:enhanced recovery after surgery、fast track surgery、ERAS、FTS、child、infant和appendicitis;中文检索关键词包括:快速康复、加速康复、儿童、小儿、婴幼儿和阑尾炎。文献截止时间为2019年3月30日,语种限制为英文及中文文献。由2名单独观察者按照标准格式进行数据提取,记录的数据包括病例数、加速康复方案、术后住院时间和并发症发生率等。采集各项指标数据后采用Revman 5.3进行Meta分析。结果最终纳入5篇有关小儿急性阑尾炎ERAS治疗的回顾性研究,共计1 295例患者。与传统治疗组相比,ERAS组在术后住院时间(MD=1.69,95%CI:0.94~2.44,P<0.05)、术后腹腔残余脓肿发生率(OR=2.53,95%CI:1.60~3.99,P<0.05)和术后再入院率(OR=1.87,95%CI:1.10~3.18,P<0.05)等方面有明显优势,组间比较,差异均有统计学意义;而在术后切口感染率(OR=0.94,95%CI:0.46~1.92,P>0.05)和术后再手术率(OR=1.72,95%CI:0.64~4.60,P>0.05)方面,两组间差异均无统计学意义。结论小儿急性阑尾炎围手术期应用ERAS理念可促进患儿康复,降低术后并发症,然而仍然需要进一步多中心大样本的前瞻性随机对照研究证实。
Objective To systematically review the outcomes of enhanced recovery after surgery (ERAS) for acute appendicitis in children. Methods A literature search was performed for the databases of PubMed, EBSCO, Medline, Cochrane, Wanfang Data and CNKI. English and Chinese keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant and appendicitis. The literature deadline was March 30, 2019 and the languages were limited to English and Chinese. The relevant data were extracted by two independent observers in a standard format, recording the number of cases, accelerated rehabilitation programs, postoperative length of stay and incidence of complications. A meta-analysis was performed with Revman 5.3 software. Results A total of 5 articles with a total of 1 295 cases were retrieved. As compared with conventional group, ERAS group had significantly shorter length of postoperative hospital stay (MD=1.69, 95%CI: 0.94-2.44, P<0.05), lower postoperative abscess rate (OR=2.53, 95%CI: 1.60-3.99, P<0.05) and reduced re-admission rate (OR=1.87, 95%CI: 1.10-3.18, P<0.05). As for postoperative incision infection rate (OR=0.94, 95%CI: 0.46-1.92, P>0.05) and re-operation rate (OR=1.72, 95%CI: 0.64-4.60, P>0.05), there was no significant inter-group difference. Conclusions ERAS is both safe and effective for acute appendicitis in children. However, more multi-center randomized control trials with larger samples should be performed for confirming.
作者
朱天琦
朱丹
余洪兴
冯杰雄
Zhu Tianqi;Zhu Dan;Yu Hongxing;Feng Jiexiong(Department of Pediatric Surgery, Affiliated Tongji Hospital, Huazhong University of Science & Technology, Wuhan 430030, China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第9期772-778,共7页
Chinese Journal of Pediatric Surgery
关键词
阑尾炎
META分析
加速康复外科
Appendicitis
Enhanced recovery after surgery
Meta-analysis
