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护理学报 ›› 2021, Vol. 28 ›› Issue (23): 41-46.doi: 10.16460/j.issn1008-9969.2021.23.041

• 循证护理 • 上一篇    下一篇

胸腔镜下肺癌根治术患者加速康复效果的Meta分析

梁冬燕1, 公丕欣2, 邱玲动2, 王慧2, 邵梅莹1, 孙铮1   

  1. 1.山东第一医科大学(山东省医学科学院),山东 泰安 271000;
    2.山东第一医科大学第二附属医院,山东 泰安 271000
  • 收稿日期:2021-03-25 出版日期:2021-12-10 发布日期:2022-01-11
  • 通讯作者: 公丕欣(1964-),女,山东临沂人,本科学历,教授,硕士研究生导师。E-mail:fygongpixin@126.com
  • 作者简介:梁冬燕(1999-),女,山东菏泽人,本科学历,硕士研究生在读。
  • 基金资助:
    山东省泰安市科学技术局项目(2018NS0132)

Rehabilitation Effect of Enhanced Recovery after Surgery on Lung Cancer Patients Undergoing Thoracoscopic Radical Surgery:A Meta Analysis

LIANG Dong-yan1, GONG Pi-xin2, QIU Ling-dong2, WANG Hui2, SHAO Mei-ying1, SUN Zheng1   

  1. 1. Shandong First Medical University (Shandong Academy of Medical Science), Tai'an 271000, China;
    2. The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, China
  • Received:2021-03-25 Online:2021-12-10 Published:2022-01-11

摘要: 目的 采用Meta分析探讨加速康复外科在肺癌患者应用胸腔镜技术中促进康复的效果。方法 计算机检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、维普数据库,收集有关胸腔镜肺癌患者围手术期应用快速康复理念的随机对照试验和临床对照试验,检索时间截止至2021年6月21日。经严格质量评价后,采用RevMan 5.3 软件进行分析。结果 共纳入14项研究,样本量共计1 587例。Meta分析结果显示,加速康复在胸腔镜肺癌手术中可降低术后肺部感染并发症发生[OR=0.43,95%CI(0.25,0.73),P=0.002]、减少住院费用[MD=-0.62,95%CI(-0.70,-0.53),P<0.001]、提前拔除胸腔引流管[MD=-2.76,95%CI(-2.96,-2.56),P<0.001]。结论 应用加速康复理念有助于促进肺癌患者的快速康复,降低肺部感染的发生,降低住院费用,符合国家医保政策,值得进一步临床推广应用。

关键词: 加速康复外科, 肺癌, 胸腔镜, Meta分析

Abstract: Objective To explore the rehabilitation effect of enhanced recovery after surgery (ERAS) in lung cancer patients undergoing thoracoscopic radical surgery. Methods We searched databases including PubMed, Web of Science, Embase, Cochrane Library, CNKI and VIP by computer to collect randomized controlled trials and clinical controlled trials on the application of ERAS in perioperative period of lung cancer patients undergoing thoracoscopic radical surgery. The search time was up to June 21, 2021 and RevMan 5.3 software was used for data analysis of the strictly screened studies. Results A total of 14 studies with a sample size of 1,587 were included. Meta analysis showed that ERAS could reduce the incidence of postoperative pulmonary infection complications [OR=0.43, 95%CI(0.25, 0.73), P=0.002] and hospitalization expenses [MD=-0.62, 95%CI(-0.70,-0.53), P<0.001], and remove the thoracic drainage tube in advance [MD=-2.76, 95%CI(-2.96, -2.56), P<0.001]. Conclusion EARS is helpful to promote the rapid rehabilitation of lung cancer patients, and reduce the incidence of pulmonary infection and hospitalization costs, which is in line with the national medical insurance policy, and worthy of further clinical application.

Key words: enhanced recovery after surgery, lung cancer, thoracoscopy, Meta-analysis

中图分类号: 

  • R473.73
[1] Nasim F, Sabath BF, Eapen GA.Lung Cancer[J]. Med Clin North Am, 2019,103(3):463-473. DOI:10.1016/j.mcna.2018.12.006.
[2] Bade BC, Dela Cruz CS.Lung Cancer 2020: Epidemiology, Etiology, and Prevention[J]. Clin Chest Med, 2020,41(1):1-24. DOI:10.1016/j.ccm.2019.10.001.
[3] Ding N, Zhou N, Li Q, et al.Analysis of Middle- and Long-term Efficacy of Thoracoscope-assisted Segmental Resection of the Lung on Non-small Cell Lung Cancer in the Early Stage[J]. Oncol Lett, 2018,15(3):3662-3668. DOI:10.3892/ol.2018.7789.
[4] Bertolaccini L, Brunelli A.Devising the Guidelines: The Techniques of Uniportal Video-assisted Thoracic Surgery-postoperative Management and Enhanced Recovery after Surgery[J]. J Thorac Dis, 2019,11(Suppl 16):S2069-S2072. DOI:10.21037/jtd.2019.01.62.
[5] Umari M, Falini S, Segat M, et al.Anesthesia and Fast-track in Video-assisted Thoracic Surgery (VATS): From Evidence to Practice[J]. J Thorac Dis, 2018,10(Suppl 4):S542-S554. DOI:10.21037/jtd.2017.12.83.
[6] 吴雪,杨川川,李燕,等.加速康复外科技术在老年肺癌手术病人中应用效果的Meta分析[J].护理研究, 2020,34(24):4324-4330.DOI:10.12102/j.issn.1009-6493.2020.24.003.
[7] 夏燕,常淑文,叶敬霆,等.快速康复外科在肺癌手术患者中应用效果的Meta分析[J].中国肺癌杂志,2016,19(12):827-836.DOI:10.3779/j.issn.1009-3419.2016.12.05.
[8] 黎慧瑜,张骞文.快速康复理念在肺切除围手术期应用疗效的meta分析[J].当代护士(下旬刊),2018,25(5):90-95.
[9] 支修益,刘伦旭.中国胸外科围手术期气道管理指南(2020版)[J].中国胸心血管外科临床杂志,2021,28(3):251-262.
[10] Higgins JPT, Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[M]. London: The Cochrane Collaboration,2011.
[11] 胡雁,郝玉芳.循证护理学[M].2版.北京:人民卫生出版社,2018:64-65.
[12] Huang H, Ma H, Chen S.Enhanced Recovery after Surgery Using Uniportal Video-assisted Thoracic Surgery for Lung Cancer: A Preliminary Study[J]. Thorac Cancer, 2018,9(1):83-87. DOI:10.1111/1759-7714.12541.
[13] Wu Y, Xu M, Ma Y.Fast-track Surgery in Single-hole Thoracoscopic Radical Resection of Lung Cancer[J]. J BUON, 2020,25(4):1745-1752.
[14] Cui Z, Zhang Y, Xu C, et al.Comparison of the Results of Two Chest Tube Managements During an Enhanced Recovery Program after Video-assisted Thoracoscopic Lobectomy: A Randomized Trial[J]. Thorac Cancer, 2019,10(10):1993-1999. DOI:10.1111/1759-7714.13183.
[15] Tahiri M, Goudie E, Jouquan A, et al.Enhanced Recovery after Video-assisted Thoracoscopic Surgery Lobectomy: A Prospective, Historically Controlled, Propensity-matched Clinical Study[J]. Can J Surg, 2020,63(3):E233-E240. DOI:10.1503/cjs.001919.
[16] Dong Q, Zhang K, Cao S, et al.Fast-track Surgery Versus Conventional Perioperative Management of Lung Cancer-associated Pneumonectomy:A Randomized Controlled Clinical Trial[J]. World J Surg Oncol, 2017,15(1):20. DOI:10.1186/s12957-016-1072-5.
[17] 蔡秋霞,张立君,朱伟伟.肺癌胸腔镜手术患者的多学科加速康复外科护理[J].护理学杂志,2018,33(19):26-29.DOI: 10.3870/j.issn.1001-4152.2018.19.026.
[18] 任占良,张泳,任小朋,等.加速康复理念在单孔胸腔镜肺癌根治术的应用[J].中华腔镜外科杂志(电子版),2017,10(6):376-380.DOI:10.3877/cma.j.issn.1674-6899.2017.06.014.
[19] 张振龙,潘小杰,欧德彬.加速康复外科理念在胸腔镜肺癌根治术的应用[J].中国康复医学杂志,2019, 34(8):950-953.DOI: 10.3969/j.issn.1001-1242.2019.08.014.
[20] 方忠民,蓝斌,杨彦龙,等.快速康复外科理念在胸腔镜肺癌手术中的应用[J].广东医学,2015,36(8):1226-1229.DOI:10.13820/j.cnki.gdyx.2015.08.020.
[21] 闻作川,郑翔,王辉,等.快速康复外科理念在胸腔镜肺癌手术中的应用分析[J].生物技术世界,2016(5):124.
[22] 王文昊,朱自江,袁继宝,等.快速康复外科理念在胸腔镜下肺癌根治围手术期的临床应用[J].实用医药杂志,2017,34(6):513-515.DOI:10.14172/j.issn1671-4008.2017.06.014.
[23] 王峻峰,倪斌,马海涛.快速康复外科在老年肺癌胸腔镜手术中的应用研究[J].腹腔镜外科杂志, 2015,20(8):581-585.DOI:10.13499/j.cnki.fqjwkzz.2015.08.581.
[24] 李英,易红梅,肖英,等.快速康复外科在胸腔镜肺癌根治术中的应用研究[J].临床误诊误治,2017,30(2):86-89.DOI: 10.3969/j.issn.1002-3429.2017.02.026.
[25] 冀亚秋. 术后快速康复对胸腔镜肺癌根治术围手术期的护理效果[J].西藏医药,2019,40(6):89-91.
[26] Castelino T, Fiore JF Jr, Niculiseanu P, et al.The Effect of Early Mobilization Protocols on Postoperative Outcomes Following Abdominal and Thoracic Surgery: A Systematic Review[J]. Surgery, 2016,159(4):991-1003. DOI:10.1016/j.surg.2015.11.029.
[27] Rogers LJ, Bleetman D, Messenger DE, et al.The Impact of Enhanced Recovery after Surgery (ERAS) Protocol Compliance on Morbidity from Resection for Primary Lung Cancer[J]. J Thorac Cardiovasc Surg, 2018, 155(4):1843-1852. DOI:10.1016/j.jtcvs.2017.10.151.
[28] 邓永鸿,张慧,曾子,等.加速康复外科护理对膝关节置换术患者膝关节功能影响的系统评价[J].护理学报,2017,24(12):27-32. DOI:10.16460/j.issn1008-9969.2017.12.027.
[29] 加速康复外科围术期营养支持中国专家共识(2019版)[J].中华消化外科杂志,2019,18(10):897-902.
[30] 刘美玲,龚桂芳,肖玉梅,等.日间病房妇科腹腔镜手术患者快速康复循证护理实践[J].护理学报,2019,26(15):31-35.DOI:10.16460/j.issn1008-9969.2019.15.031.
[31] Ueda K, Hayashi M, Tanaka T, et al.Omitting Chest Tube Drainage after Thoracoscopic Major Lung Resection[J]. Eur J Cardiothorac Surg, 2013,44(2):225-229. DOI:10.1093/ejcts/ezs679.
[32] Deng B, Qian K, Zhou JH, et al.Optimization of Chest Tube Management to Expedite Rehabilitation of Lung Cancer Patients after Video-assisted Thoracic Surgery:A Meta-analysis and Systematic Review[J]. World J Surg, 2017,41(8):2039-2045. DOI:10.1007/s00268-017-3975-x.
[33] Shen C, Che G.No Drains in Thoracic Surgery with ERAS Program[J]. J Cardiothorac Surg, 2020,15(1):112. DOI:10.1186/s13019-020-01164-5.
[34] Brunelli A.Enhanced Recovery Pathways in Thoracic Surgery: Time for a Version 2.0[J]. J Thorac Cardiovasc Surg, 2018, 155(6):2758-2759. DOI:10.1016/j.jtcvs.2018.01.073.
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