摘要
目的探讨三联预康复方案对食管癌患者术后临床结局的影响,为临床加速康复外科的发展提供循证支持。方法2人系统检索Pubmed、Embase、Web of Science、The Cochrane Library、CINAHL、Medline、Ovid等外文数据库和CNKI、维普、万方、中国生物医学文献数据库(CBM)等中文数据库,纳入有关食管癌手术患者实施三联预康复的研究文献,分别采用Cochrane 5.1.0质量评价标准、纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对RCT研究和队列研究进行独立文献质量评价,并采用Revman5.2软件进行Meta分析。结果经过筛选后共纳入9篇文献,其中随机对照研究6篇,3篇队列研究,总样本量为935例食管癌患者。研究结果表明,三联预康复组患者术后总并发症[RR=0.45,95%CI(0.38,0.53),P<0.01]、肺部感染[RR=0.51,95%CI(0.39,0.67),P<0.01]、吻合口瘘[RR=0.32,95%CI(0.13,0.74),P<0.01]均少于对照组;住院总时长[MD=-2.29,95%CI(-3.80,-0.78),P<0.05]、[ICU住院时长MD=-0.36,95%CI(-0.43,-0.28),P<0.05]缩短;但对术前BMI[MD=0.67,95%CI(-0.01,1.35),P=0.05]、30 d再入院率[RR=1.21,95%CI(0.67,2.20),P=0.53]影响不存在显著性。结论三联预康复模式能显著降低食管癌患者术后并发症的发生率,并缩短患者住院时长。提示未来临床可采用三联预康复模式(即运动干预、营养干预和心理干预)对食管癌围术期患者进行干预,以改善患者的生活质量和预后。但多数研究未测评食管癌患者的心理状况,未来研究可进一步关注食管癌患者的心理干预效果。
Objective To explore the effect of triple pre-rehabilitation program on the postoperative clinical outcomes in patients with esophageal cancer,and provide evidence-based support for the development of clinical enhanced recovery after surgery.Methods Two researchers systematically searched foreign databases such as PubMed,Embase,Web of Science,The Cochrane Library,CINAHL,Medline,and Ovid,as well as Chinese databases such as CNKI,VIP,Wanfang,and China Biology Medicine disc(CBM),to include relevant research literature on the implementation of triplet pre-rehabilitation in patients undergoing esophageal cancer surgery.Cochrane 5.1.0 quality assessment criteria and Newcastle-Ottawa Scale(NOS)were used to independently evaluate the quality of RCT and cohort studies.Meta-analysis was conducted using Revman 5.2 software.Results After screening,a total of 9 articles were included,including 6 randomized controlled studies and 3 cohort studies,with a total sample size of 935 patients with esophageal cancer.The results of the study showed that the total postoperative complications[RR=0.45,95%CI(0.38,0.53),P<0.01],pulmonary infection[RR=0.51,95%CI(0.39,0.67),P<0.01],and anastomotic leak[RR=0.32,95%CI(0.13,0.74),P<0.01]of patients in the triple pre-rehabilitation group were fewer than those in the control group;the total length of hospital stay[MD=-2.29,95%CI(-3.80,-0.78),P<0.05]and ICU stay[MD=-0.36,95%CI(-0.43,-0.28),P<0.05]were also shortened.However,there was no significant impact on preoperative BMI[MD=0.67,95%CI(-0.01,1.35),P=0.05]and the rate of readmission within 30 days[RR=1.21,95%CI(0.67,2.20),P=0.53].Conclusion The triplet pre-rehabilitation model significantly reduces the incidence of postoperative complications in patients with esophageal cancer and shortens their hospital stay.This suggests that for future clinical practice,the triplet pre-rehabilitation model(including exercise intervention,nutritional intervention,and psychological intervention)can be used to intervene in perioperative patients with esophageal cancer,thereby improving patients'quality of life and prognosis.However,most studies did not assess the psychological status of patients with esophageal cancer.Future research could further focus on the effects of psychological interventions on patients with esophageal cancer.
作者
冷英杰
张浩
王国蓉
谢若男
蒋欣
李成香
聂茁苗
LENG Yingjie;ZHANG Hao;WANG Guorong;XIE Ruonan;JIANG Xin;LI Chengxiang;NIE Zhuomiao(Nursing College of Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China;Nursing College of Chengdu Medical University,Chengdu 610500,China;West China Public Health College of Sichuan University,Chengdu 610041,China)
出处
《护理实践与研究》
2024年第7期1008-1015,共8页
Nursing Practice and Research
基金
成都医学院研究生科研创新基金项目(编号:YCX2023-01-51)。
关键词
食管肿瘤
三联预康复
预康复
心理
META分析
Esophageal cancer
Triple pre-rehabilitation
Pre-rehabilitation
Psychology
Meta-analysis
作者简介
通信作者:王国蓉,女,主任护师,硕士研究生导师,E-mail:553999838@qq.com。
