摘要
目的评价缩短择期手术前禁食禁饮时间对病人围手术期的影响,分析其安全性和可行性。方法计算机检索PubMed、Embase、The CochraneLibrary、CNKI、CBM及万方数据库,收集所有符合纳入标准的随机对照试验(RCT),检索时限为1998年1月~2018年8月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量,采用RevMan 5.3软件进行荟萃分析。结果共纳入29篇研究,包括3049例病人。结果显示:(1)新方案能减少术前饥饿感[OR=0.17,95%CI(0.10,0.29),P<0.05]、口渴感[OR=0.15,95%CI(0.07,0.31),P<0.05],虚脱[OR=0.15,95%CI(0.06,0.38),P<0.05]、低血糖[OR=0.04,95%CI(0.01,0.13),P<0.05]发生率较低;(2)术前胃液残余量、术前胃液pH、术中胃液量方面差异无统计学意义(P>0.05);(3)新方案术后24小时血糖浓度[MD=-0.56,95%CI(-0.71,-0.42),P<0.05]、胰岛素浓度[MD=-3.60,95%CI(-5.02,-2.18),P<0.05]、胰岛素抵抗指数[MD=-2.41,95%CI(-3.11,-1.72),P<0.05]均低于传统方案。结论新禁食禁饮方案安全、可行,不仅可减轻病人术前主观不适感,也未增加麻醉风险,且可改善围手术期代谢。
Objective To explore the safety and feasibility of shortening fasting and banning time on the selective perioperative period of patients.Methods The PubMed,Embase,Cochrane Library,CNKI,CBM and Wanfang Data were searched for the randomized controlled trials(RCTs)between Jan,1998 and Aug,2018.Data extraction and screening were performed by two researchers independently.Meta analysis was conducted using RevMan 5.3 software.Results 29 studies comprising 3049 patients were eligible for inclusion.Meta analysis showed that there were less hunger[OR=0.17,95%CI(0.10,0.29),P<0.05],thirst[OR=0.15,95%CI(0.07,0.31),P<0.05],fatigue[OR=0.04,95%CI(0.01,0.13),P<0.05]and hypoglycemia[OR=0.15,95%CI(0.06,0.38),P<0.05]in new plan than in traditional plan.However,no significant differences were found in preoperative and intraoperative gastric secretion.Furthermore,the new plan was better than traditional plan in postoperative serum glucose[MD=-0.56,95%CI(-0.71,-0.42),P<0.05],insulin[MD=-3.60,95%CI(-5.02,-2.18),P<0.05],insulin resistance index[MD=-2.41,95%CI(-3.11,-1.72),P<0.05].Conclusion The new plan is safe,feasible and recommended to be applied in clinical practice.It has advantages over traditional plan as it can reduce postoperative subjective discomfort,improve the perioperative metabolism and without increase the risk of anesthesia.
作者
张颖
张燕
王晶晶
ZHANG Ying;ZHANG Yan;WANG Jingjing(Department of Head&Neck,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《临床外科杂志》
2020年第2期151-154,共4页
Journal of Clinical Surgery
关键词
择期手术
术前
禁食禁饮
安全性
可行性
META分析
selective surgery
preoperative
fasting and water deprivation
security
feasibility
Meta analysis
作者简介
通信作者:张颖,Email:zhangying_bjmu@163.com
