目标导向液体治疗对胸科手术患者术中氧供需平衡及术后结局影响的Meta分析

目的 系统评价目标导向液体治疗对胸科手术患者术中氧供需平衡及术后结局的影响。方法 计算机检索PubMed、Cochrane Library、VIP、CNKI、WanFang Database(建库至2019年10月),按照纳入与排除标准选择文献、评价质量并提取资料后,采用RevMan 5.3软件进行Meta分析。结果 共纳入符合条件的11个随机对照试验(RCT),共计810例患者。Meta分析结果显示:目标导向组增加患者术中氧合指数(OI)单肺通气结束时:MD=57.04, 95%CI(24.04, 90.05),P=0.001;术毕:MD=97.33, 95%CI(27.21, 167.45),P=0.007],降低术毕血乳酸(Lac)水平MD=-0.51, 95%CI(-0.84,-0.18),P=0.002],提高术中心脏指数(CI)单肺通气结束时:MD=0.42, 95%CI(0.23, 0.61),P<0.01;术毕:MD=0.40, 95%CI(0.26, 0.54),P<0.01],降低术后肺部感染发生率RR=0.35, 95%CI(0.16, 0.76),P=0.008]、急性肺损伤发生率RR=0.15, 95%CI(0.04, 0.67),P=0.010]、术后恶心呕吐发生率RR=0.39, 95%CI(0.22, 0.68),P=0.001],减少住院天数MD=-0.66, 95%CI(-1.20, -0.12),P=0.020]。结论 目标导向液体治疗可改善胸科手术患者组织灌注、维持氧供需平衡,减少术后恶心呕吐及肺部相关并发症,降低患者医疗花费, 提高预后。

Effects of goal-directed fluid therapy on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in thoracic surgery patients: a meta-analysis

Objective To systematically evaluate the effects of goal-directed fluid therapy (GDFT) on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in patients undergoing thoracic surgery. Methods We searched PubMed, Cochrane Library, VIP, CNKI and WanFang Database from inception to October 2019, literature selection, quality evaluation and data extraction were performed according to inclusion and exclusion criteria, and meta-analysis was completed by RevMan 5.3. Results A total of 11 eligible randomized controlled trials (RCTs) were enrolled, including 810 patients. The results of meta-analysis showed that intraoperative oxygenation index (OI) was significantly increased by the use of GDFT for thoracic surgery patients (at the end of one-lung ventilation OLV]: MD=57.04, 95%CI 24.04, 90.05], P=0.001; at the end of surgery: MD=97.33, 95%CI27.21, 167.45], P=0.007), significantly decreased for postoperative blood lactic acid (Lac) (MD=-0.51, 95%CI-0.84, -0.18], P=0.002), significantly increased for intraoperative cardiac index (CI) (at the end of OLV: MD=0.42, 95%CI 0.23, 0.61], P<0.01; at the end of surgery: MD=0.40, 95%CI0.26, 0.54], P<0.01); meanwhile, incidence of postoperative complications were significantly decreased with use of GDFT, including the incidence of postoperative pulmonary infection (RR=0.35, 95%CI0.16, 0.76], P=0.008), incidence of acute lung injury (ALI) (RR=0.15, 95%CI0.04, 0.67], P=0.010), incidence of postoperative nausea and vomiting (PONV) (RR=0.39, 95%CI 0.22, 0.68], P=0.001), as well as reduced hospitalization time in GDFT group (MD=-0.66, 95%CI -1.20, -0.12], P=0.020).Conclusion For thoracic surgery patients, using GDFT can effectively improve tissue perfusion and balance of oxygen delivery and consumption, reduce incidence of PONV and complications of pulmonary, decrease medical expenses, and improve the prognosis of patients.