手术后增强的恢复方案:心脏手术随机试验的系统审查和元分析
Cristiano Spadaccio1,2, Antonio Salsano3, Angelo Pisani4
1Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World journal of surgery
|February 29, 2024
概括
心脏外科手术中的增强术后恢复 (ERAS) 协议可以减少住院和并发症,但不会影响短期生存. 由于当前ERAS协议的异质性,需要进行进一步的研究.
科学领域:
- 心脏病学 心脏病学
- 外科手术的结果
- 关键护理医学 关键护理医学
背景情况:
- 之前的元分析表明,手术后增强恢复 (ERAS) 协议有利于心脏手术患者.
- 然而,随机研究和全面的ERAS途径实施的最终数据尚缺.
- 现有的文献通常集中在"ERAS类"协议或有限的ERAS组件上.
研究的目的:
- 分析心脏外科手术中ERAS类协议的所有随机研究.
- 评估ERAS类协议对外科手术期间结果的影响.
主要方法:
- 对随机对照试验 (RCT) 的元分析,将ERAS类与标准外科手术期间护理进行比较.
- 在数据抽象和评估方面遵循了PRISMA指南.
- 在PROSPERO注册过程中,CRD42021283765.
主要成果:
- 包括13个RCT (N=1704),主要涉及手术复血管化 (66.3%) 和膜手术 (24.9%).
- 在住院死亡率中没有发现显著差异 (RR 0.61,p=0.15).
- ERAS协议与急症监护室停留时间 (SMD -0.57,p<0.01),住院时间 (SMD -0.23,p<0.01) 和整体并发症 (RR 0.60,p<0.01),特别是中风 (RR 0.29,p<0.01) 的减少有关.
- 在研究中使用的ERAS协议元素中发现了显著的异质性.
结论:
- 类似ERAS的协议不会影响心脏手术中的短期存活率,但有助于更快的出院.
- 埃拉斯 (ERAS) 协议显示了减少手术并发症的潜力.
- 由于ERAS协议的实施中存在显著的不合规性和异质性,因此需要进一步的RCT,将ERAS框架的更多元素纳入其中.
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