收稿日期: 2022-09-22
录用日期: 2022-12-27
网络出版日期: 2023-01-28
基金资助
上海市加强公共卫生体系建设三年行动计划(GWV-5);上海交通大学医学院护理学科建设项目;上海市第一人民医院特色研究项目(CTCCR-2021C08)
Effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery: a systematic review
Received date: 2022-09-22
Accepted date: 2022-12-27
Online published: 2023-01-28
Supported by
Three-year Action Plan for Strengthening Public Health System in Shanghai (GWV-5);Nursing Development Program of Shanghai Jiao Tong University School of Medicine;Clinical Research Innovation Plan of Shanghai General Hospital(CTCCR-2021C08)
目的·系统评价预康复对择期行胃肠道手术患者术后恢复的影响。方法·系统检索PubMed、EMbase、Cochrane Library、Web of Science、CINAHL、中国生物医学文献数据库（CBM）、中国知网、万方、维普数据库，检索时限均为建库至2022年1月31日。按照预先设定的标准筛选文献，对文献质量进行评价并提取资料，对纳入的随机对照试验采用RevMan 5.4进行meta分析。主要观察指标为术后总体并发症发生率和手术部位感染发生率，次要观察指标为住院天数、６ min步行试验（6-minute walk test，6MWT）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale，HADS）评分，以及死亡率和预康复执行的依从性。结果·共纳入16篇文献，其中英文15篇，中文1篇，共1 616例研究对象，纳入研究的总体质量较好。Meta分析结果显示，相较于对照组，实施了预康复的试验组患者术后总体并发症的发生率降低［比值比（odds ratio，OR）=0.57，95%置信区间（confidence interval，CI）0.35~0.94，P=0.030］，手术部位感染发生率降低（OR=0.64，95%CI 0.46~0.90，P=0.009），住院天数缩短［均数差值（mean difference，MD）=-2.45，95%CI -3.17~-1.73，P=0.000］。2组患者术前6MWT水平的差异无统计学意义；试验组术前6MWT水平相较于基线的提升程度优于对照组（MD=24.19，95%CI 3.77~44.60，P=0.020）。2组患者术前HADS评分和术后死亡率差异均无统计学意义。结论·预康复有利于降低胃肠道择期手术患者术后总体并发症发生率，尤其是手术部位感染发生率，从而缩短住院天数，有利于患者康复。
方芳 , 台瑞 , 余倩 , 章雅青 . 预康复对胃肠道择期手术患者术后恢复效果的系统评价[J]. 上海交通大学学报（医学版）, 2023 , 43(1) : 70 -78 . DOI: 10.3969/j.issn.1674-8115.2023.01.009
Objective ·To systematically evaluate the effect of prehabilitation on outcomes in patients undergoing elective gastrointestinal surgery. Methods ·PubMed, EMbase, Cochrane Library, Web of Science, CINAHL, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and VIP Database were searched systematically from the establishment of each database to January 31, 2022. The literatures were screened, and evaluated according to the preset inclusion and exclusion criteria. The literature quality was evaluated and the data were extracted. Meta-analysis was performed on randomized controlled trials by using RevMan 5.4. The main observation indexes were the postoperative complication rate and the incidence of surgical site infection. The secondary indexes were hospitalization days, 6-minute walk test (6MWT), Hospital Anxiety and Depression Scale (HADS) score, mortality and compliance of prerehabilitation execution. Results ·Sixteen articles were included, including 15 articles in English and 1 article in Chinese, with a total of 1 616 patients. The overall quality of the included researches was good. The meta-analysis results showed that compared with the control group, the incidences of postoperative complications and surgical site infection were reduced [(odds ratio, OR)=0.57, 95% (confidence interval, CI)0.35?0.94, P=0.030; OR=0.64, 95%CI 0.46?0.90, P=0.009]; the length of hospital stay was shortened [mean difference (MD)=-2.45, 95%CI -3.17 ? -1.73, P=0.000] in the experimental group after the implementation of prehabilitation. There was no significant difference in preoperative 6MWT level between the two groups. Compared with the baseline, the change of 6MWT level before operation of the experimental group was bigger than that of the control group (MD=24.19, 95%CI 3.77?44.60, P=0.020). There were no significant differences in the preoperative HADS score and the postoperative mortality between the two groups. Conclusion ·Prehabilitation can reduce the incidence of postoperative complications, especially surgical site infection, in patients undergoing elective gastrointestinal surgery, thus shortening the length of hospital stay and promoting the recovery of patients.
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