The use of leukoreduced red blood cell products is associated with fewer infectious complications in trauma patients

BACKGROUND: Clinical studies suggest that leukocytes in banked blood may increase infectious complications after transfusion. However, these investigations included few injured patients. Therefore, the effect of the use of leukoreduced red blood cell (RBC) products in this patient population is unknown. In addition, large numbers of RBC transfusions are frequently required in the treatment of patients with hemorrhagic shock, which may have a more profound effect on infectious risk. The purpose of this study was to determine the effect of prestorage leukoreduction on infectious complications in injured patients. METHODS: A retrospective before-and-after cohort study was conducted at an urban level 1 trauma center. A policy of using leukoreduced RBC products commenced in January 2002. Patients treated from March 2002 through December 2003 received leukoreduced RBC products. Those transfused from March 2000 through December 2001 served as controls. Inclusion criteria were age >or=18 years, survival >or=2 days after admission, and transfusion of >or=2 U RBCs within 24 hours of admission. There were 240 patients in the leukoreduction group, and 438 patients in the control group. Multivariate logistic regression controlling for age, sex, injury severity, and number of transfusions was used to determine if leukoreduction status was an independent predictor of infectious complications. Subset analysis was performed on patients receiving massive transfusion (ie, >6 units in 24 hours; n = 168). RESULTS: Patient demographics and injury severity characteristics were similar during both treatment periods. Overall, those patients receiving leukoreduced RBC products had a 45% reduction in nosocomial pneumonia (odds ratio [OR] .55; 95% confidence interval [CI] .33-.91) and a significant reduction in the development of any type of infection (OR .48; 95% CI .31-.73). In the massive-transfusion subset, the OR for development of any infection was .33 (95% CI, .15-.73), and the OR for the development of pneumonia was .29 (95% CI, .11.76) in those patients receiving leukoreduced RBC products. There were no differences in mortality within the overall- or massive-transfusion subset analyses. CONCLUSION: Prestorage leukoreduction is associated with a reduction of infectious complications in injured patients. Furthermore, this protective effect appears more pronounced in patients receiving massive transfusion (>6 U packed RBCs).     

直肠癌低位前切除术中预防性肠造瘘必要性的Meta分析

目的探讨吻合口在腹膜反折以下的直肠癌低位前切除术中预防性肠造瘘的必要性。方法检索Medline、Embase、Cochrane Library、万方和中国知网（CNKI）数据库,对符合纳入标准的文章进行Meta分析。结果6篇随机对照研究（包括648例低位直肠癌患者,其中预防性造瘘组332例．未造瘘组316例）和25篇回顾性对照研究（包括10722例低位直肠癌患者,其中预防性造瘘组4470例,未造瘘组6252例）纳入研究分析。综合分析显示,与未造瘘组比较,预防性肠造瘘能够降低术后吻合口瘘发生率（随机对照研究RR=0．33,95％CI：0．21-0．53;回顾性对照研究OR=0．60,95％CI：0．42-0．85）、吻合口瘘再手术率（随机对照研究RR=0．30,95％CI：0．16～0．53;回顾性对照研究OR=0．26：95％CI：0．21～0．32）及吻合口瘘相关死亡率（回顾性对照研究OR=0．41;95％CI：0．27～0．62）（均P〈0．05）。结论对于具有术后吻合口瘘高危因素的直肠癌患者,行低位前切除术中应常规行预防性造瘘。     

Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: A meta-analysis

Objectives

This meta-analysis was conducted to compare the early and follow-up outcomes of aortic valve replacement using rapid deployment or sutureless (RD) valves (RDAVR group) with aortic valve replacement using conventional bioprostheses (CAVR group).

Intensive insulin therapy in brain injury: a meta-analysis

Many studies have addressed the question of whether intensive insulin therapy (IIT) provides better outcomes for brain-injured patients than does conventional insulin therapy (CIT), with conflicting results. We performed a systematic review and meta-analysis of the literature to estimate the effect of IIT on patients with brain injury. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and citations of key articles and selected "all randomized controlled trials" (RCTs) comparing the effect of IIT to CIT among adult patients with acute brain injury (traumatic brain injury, stroke, subarachnoid hemorrhage, and encephalitis). Of the 2807 studies, we identified 9 RCTs with a total of 1160 patients for analysis. IIT did not appear to decrease the risk of in-hospital or late mortality (RR=1.04, 95% CI=0.75, 1.43 and RR=1.07, 95%CI=0.91, 1.27 respectively). No significant heterogeneity was found (I(2)=0.0%). IIT also did not have a protective effect on long-term neurological outcomes (LTNO) (RR=1.10, 95% CI=0.96, 1.27). IIT, however, did decrease the rate of infections (RR=0.76, 95% CI=0.58, 0.98). Heterogeneity was present (I(2)=64%), which was eliminated upon sensitivity analysis bringing the RR to 0.66 (95% CI=0.55, 0.80, I(2)=0%). IIT increased the rate of hypoglycemic episodes (RR=1.72, 95% CI=1.20, 2.46) however there was intractable heterogeneity present (I(2)=89%), which did not resolve upon sensitivity analysis. We found no evidence of publication bias by Egger's test (p=0.50). To conclude, IIT has no mortality or LTNO benefit to patients with brain injury, but is beneficial at decreasing infection rates.     

N-acetylcysteine to reduce renal failure after cardiac surgery: a systematic review and meta-analysis

Purpose: To assess the effect of N-acetylcysteine (NAC) on acute renal failure and important clinical outcomes after cardiac surgery. Methods: Two reviewers performed literature searches, using EMBASE and PubMed, of randomized controlled trials investigating the renoprotective effect of N-acetylcysteine in cardiac surgery. Treatment effects were calculated as relative risks (RR) with 95% confidence intervals (CI). Heterogeneity and publication bias were assessed using the I² test and funnel plots, respectively. Meta regression was performed to assess the effect of baseline renal function and the use of aprotinin on renal function. Results: Seven randomized controlled trials (RCTs) (n=1000) were identified. No study could demonstrate, either independently or meta-analytically, an improvement in the postoperative increase in creatinine, mortality (RR 0.93, 95% CI 0.4 to 2.07), renal failure requiring renal replacement therapy (RR 1.01, 95% CI 0.49 to 2.12), myocardial infarction (RR 0.88, 95% CI 0.36 to 1.88), atrial fibrillation (RR 0.88, 95% CI 0.70 to 1. 10), or stroke (RR 0.69, 95% CI 0.27 to 1.69). There was a small, though significant increase in postoperative blood loss among patients treated with NAC (weighted mean difference I 19 mL 95% CI 51, 187). After meta regression neither increase in postoperative creatinine (r²=0.33) nor renal replacement therapy (r²=0.04) was associated with the baseline creatinine or with NAC dose (r²=0.04). Conclusion: This analysis did not find that treatment with NAC was associated with clinical renal protection during cardiac surgery, or improvement in other clinical outcomes.     

Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials

Postoperative pain management remains a significant challenge for all healthcare providers. The objective of this systematic review was to quantitatively evaluate the efficacy of acupuncture and related techniques as adjunct analgesics for acute postoperative pain management. We searched the databases of Medline (1966-2007), CINAHL, The Cochrane Central Register of Controlled Trials (2006), and Scopus for randomized controlled trials (RCTs) using acupuncture for postoperative pain management. We extracted data about postoperative opioid consumption, postoperative pain intensity, and opioid-related side-effects. Combined data were analysed using a random effects model. Fifteen RCTs comparing acupuncture with sham control in the management of acute postoperative pain were included. Weighted mean difference for cumulative opioid analgesic consumption was -3.14 mg (95% confidence interval, CI: -5.15, -1.14), -8.33 mg (95% CI: -11.06, -5.61), and -9.14 mg (95% CI: -16.07, -2.22) at 8, 24, and 72 h, respectively. Postoperative pain intensity (visual analogue scale, 0-100 mm) was also significantly decreased in the acupuncture group at 8 and 72 h compared with the control group. The acupuncture treatment group was associated with a lower incidence of opioid-related side-effects such as nausea (relative risk, RR: 0.67; 95% CI: 0.53, 0.86), dizziness (RR: 0.65; 95% CI: 0.52, 0.81), sedation (RR: 0.78; 95% CI: 0.61, 0.99), pruritus (RR: 0.75; 95% CI: 0.59, 0.96), and urinary retention (RR: 0.29; 95% CI: 0.12, 0.74). Perioperative acupuncture may be a useful adjunct for acute postoperative pain management.     

Dexmedetomidine for preventing sevoflurane‐related emergence agitation in children: a meta‐analysis of randomized controlled trials

Emergence agitation (EA) is a common problem after sevoflurane anesthesia in children. Prophylactic dexmedetomidine has been directed at this issue; however, the efficacy remains controversial. We therefore conducted a meta‐analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of dexmedetomidine on the incidence of sevoflurane‐related EA. A comprehensive literature search was performed to identify RCTs that compared dexmedetomidine with placebo about the reduction in the incidence of sevoflurane‐related EA for children. Heterogeneity between studies was anticipated; therefore, random effects models were chosen to calculate the pooled risk ratio (RR) and 95% confidence interval (CI), and I² statistics were used to assess statistical heterogeneity. The funnel plot and Egger test were used to assess potential publication bias. Subgroup analysis was run to explore the possible effects of age, surgical procedure, regional block/local anesthetics, supplemental analgesic, propofol, N₂O, pre‐medication and methodological quality on the incidence of EA using dexemedetomidine. Totally, 15 RCTs were included (518 patients received dexmedetomidine and 413 had placebo). Dexmedetomidine reduced the incidence of sevofurane‐related EA (pooled RR = 0.351; 95% CI: 0.275–0.449; P = 0.965; heterogeneity test, I² = 0.0%), and it also resulted in a lower incidence of severe EA (pooled RR = 0.119; 95% CI: 0.033–0.422; P = 0.962; heterogeneity test, I² = 0.0%). All subgroup analyses for potential sources of heterogeneity showed a lower incidence of sevoflurane‐related EA after dexmedetomidine administration. This meta‐analysis demonstrated that dexemedetomidine was effective in reducing the incidence of sevoflurane‐induced EA in children as compared with placebo.     

Clinical Evidence on Hemodiafiltration: A Systematic Review and a Meta‐analysis

In this review, a systematic literature search and meta‐analysis were performed to assess the effects of hemodiafiltration (HDF) on clinical outcome, as compared with hemodialysis (HD). Furthermore, the relation between the convection volume in HDF and clinical outcome was studied. The literature search identified six randomized controlled trials (RCTs). In a meta‐analysis of these RCTs, HDF treatment was related to a decreased risk of mortality (RR: 0.84; 95% CI 0.73–0.96) and cardiovascular death (RR: 0.73; 95% CI 0.57–0.92). Post hoc analyses of the three largest RCTs suggested an inverse relation between the magnitude of convection volume and mortality risk. The evidence presented in this analysis supports a wider acceptance of HDF.     

Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: A systematic review of the published literature with subgroup analysis

BACKGROUND: A systematic review was conducted to develop clinical recommendations for concomitant chemotherapy (CT) and radiotherapy (RT) in patients with locally advanced squamous cell head and neck cancer (SCHNC). METHODS: Results of published randomized controlled trials (RCTs) were pooled using Meta-analyst(0.988) software. RESULTS: A pooled analysis of 18 RCTs (20 comparisons) involving 3,192 patients detected a reduction in mortality for concomitant therapy compared with RT alone (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.52-0.74; relative risk, 0.83; risk reduction, 11%; p < .00001). Platinum-based regimens involving 1,514 patients from nine trials (10 comparisons) were most effective (OR, 0.57; 95% CI, 0.46-0.71; p < .00001; risk reduction, 12%). Concomitant therapy produced more acute adverse effects than RT alone. CONCLUSION: Platinum-based concomitant CT and RT is superior to conventional RT alone in improving survival in locally advanced SCHNC. Subgroup analyses can be used to help in choosing the most appropriate concomitant regimen.     

Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and meta-analysis

OBJECTIVES: To assess the effectiveness of preoperative intra-aortic balloon pump (IABP) placement in high-risk patients undergoing coronary bypass surgery (CABG). The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection). METHODS: MEDLINE, EMBASE, Cochrane registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs), and cohort studies that fulfilled our a priori inclusion criteria. Eligibility decisions, relevance, study validity, and data extraction were performed in duplicate using pre-specified criteria. Meta-analysis was conducted using a random effects model. RESULTS: Ten publications fulfilled our eligibility criteria, of which four were RCTs and six were cohort studies with controls. There were statistical as well as clinical heterogeneity among included studies. A total of 1034 patients received preoperative IABP and 1329 did not receive preoperative IABP. The pooled odds ratio (OR) for hospital mortality in patients treated with preoperative IABP was 0.41 (95% CI, 0.21-0.82, p = 0.01). The number needed to treat was 17. The pooled OR for hospital mortality from randomized trials was 0.18 (95% CI, 0.06-0.57, p = 0.003) and from cohort studies was 0.54 (95% CI, 0.24-1.2, p = 0.13). Overall, 3.7% (13 of 349) of patients who received preoperative IABP developed either limb ischemia or haematoma at the IABP insertion site, and most of these complications improved after discontinuation of IABP. CONCLUSION: Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality.     

Patients' global evaluation of analgesia and safety of injected parecoxib for postoperative pain: a quantitative systematic review

Parecoxib is the only parenterally administered cyclooxygenase-2-selective inhibitor available. We performed a systematic review, including full reports of randomized comparisons of parecoxib compared with any other analgesic intervention for prophylaxis or treatment of postoperative pain. Dichotomous data on patients' global evaluation of their analgesic regimen were extracted by means of the fraction of patients who rated their medication as "good" or "excellent." For safety analysis, data on any reported adverse effects were extracted. Relative risk (RR), number needed to treat (NNT), or number-needed-to-harm were calculated with 95% confidence intervals (CI). Data from 9 trials of 50 initially screened were finally analyzed. One thousand thirteen patients were randomized to receive parecoxib, 218 patients were allocated to an active control, and 507 patients received a placebo. With prophylactic administration, the pooled NNT to obtain the desired outcome ("good"/"excellent" rating) with parecoxib 20 and 40 mg compared with placebo was 4.5 (RR, 1.42; 95% CI, 0.91-2.24) and 4.0 (RR, 1.40; 95% CI, 1.10-1.79), respectively. In the treatment trials, the NNT to obtain the outcome of interest with parecoxib 20 mg was 2.1 (RR, 3.44; 95% CI, 1.49-7.96), 5.3 (RR, 1.43; 95% CI, 1.01-2.02), and -8.3 (RR, 0.85; 95% CI, 0.75-0.97) for the comparisons with placebo, morphine, and ketorolac, respectively. The corresponding NNT for treatment with parecoxib 40 mg was 1.7 (RR, 4.65; 95% CI, 2.04-10.61), 3.7 (RR, 1.62; 95% CI, 1.21-2.16), and 50 (RR, 1.03; 95% CI, 0.89-1.18) for the comparisons with placebo, morphine, and ketorolac, respectively. Overall adverse effects for parecoxib 20 and 40 mg were not different from those with placebo, morphine, or ketorolac. These results suggest a favorable profile for parecoxib compared with inactive or active controls. The optimal dose, timing, and frequency of administration need to be determined.     

Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis.

OBJECTIVE: Despite numerous studies comparing surgical versus percutaneous revascularization, the optimal treatment of patients with isolated left anterior descending (LAD) artery disease remains debated. We conducted a meta-analysis to study the early and mid-term outcomes following percutaneous and surgical treatment of isolated LAD disease. METHODS: Medline, EMBASE, and the Cochrane databases were searched and a hand search of bibliographies was conducted. Clinical data was extracted independently by two individuals. Random effects models were used to calculate pooled risk ratios (RR) and meta-regression was employed to explain study heterogeneity. Stratified analyses were conducted and a Funnel plot was used to assess publication bias. RESULTS: Eight randomized trials (1110 patients; median follow-up: 2.1 years, range: 0.5-5 years) and nine observational studies (12,209 patients; median follow-up: 3 years, range: 0.5-5.5 years) were identified and analyzed separately. Both randomized and observational studies demonstrated a beneficial effect of surgery compared to percutaneous therapy on mid-term major adverse cardiac events (MACE) (RR [95% CI]: 0.33 [0.24-0.46] for randomized and 0.32 [0.24-0.41] for observational studies). Studies with >1 year of follow-up demonstrated a beneficial effect of surgery compared to percutaneous therapy on combined mortality and MI rates for randomized (RR [95% CI]: 0.59 [0.35-0.98]) and observational studies (RR [95% CI]: 0.81 [0.65-0.99]). The start year was identified as a source of study heterogeneity. CONCLUSIONS: Surgical treatment of isolated LAD disease is associated with reduced MACE, reduced mortality, and MI rates at mid-term follow-up, as well as lower recurrence of angina. Evolution of treatment strategies may explain some of the variability between studies.     

维生素K2防治绝经后骨质疏松症作用的荟萃分析

目的 为了确定维生素K2对绝经后骨质疏松症(postmenopausal osteoporosis, PMOP)患者的预防和治疗作用,我们对22项随机对照试验进行了荟萃分析。方法 在PubMed、Cochrane Library、Embase数据库和三个中文数据库(CBM、CNKI和万方)检索了2020年6月1日之前发布的相关随机对照试验(RCT),以维生素K2与安慰剂或其他抗骨质疏松药物预防和治疗PMOP进行比较。使用固定效应或随机效应模型计算合并风险比(RR)、平均值(MD)和95％置信区间(CI)。结果 包括7 154名绝经女性参与的22项随机对照试验符合纳入标准。补充维生素K2 12个月后改善绝经后女性腰椎骨密度优于对照组(P = 0.03),PMOP亚组腰椎骨密度改善较对照组差异有统计学意义 (P = 0.03)。补充维生素K2预防绝经后女性椎体骨折发生率优于对照组(RR = 0.52, 95 % CI: 0.36~0.74, P = 0.003),PMOP亚组椎体骨折发生率低于对照组(P = 0.006)。补充维生素K2显著降低低羧化骨钙素(ucOC)(P <0.001)。补充维生素K2药物不良反应略高于对照组(RR=1.29, 95 % CI:1.03~1.63, P = 0.03)。结论 补充维生素K2 12个月后有效改善绝经后女性腰椎骨密度,预防椎体骨折,降低ucOC,PMOP患者获益更大。口服维生素K2被认为是安全的。     

The effectiveness and safety of rituximab as induction therapy in ABO-compatible non-sensitized renal transplantation: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The objective of this systematic review and meta-analysis was to evaluate the effectiveness and safety of rituximab as induction therapy in ABO-compatible, non-sensitized renal transplantation. Methods: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2015. Studies that reported relative risks or hazard ratios comparing the risks of biopsy-proven acute rejection (BPAR), graft loss, leukopenia, infection or mortality in ABO-compatible, non-sensitized renal transplant recipients who received rituximab as induction therapy versus controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method. Results: Four RCTs with 480 patients were included in the meta-analysis. Pooled RR of BPAR in recipients with rituximab induction was 0.90 (95% CI 0.50–1.60). Compared to placebo, the risk of BPAR in rituximab group was 0.76 (95% CI 0.51–1.14, I²?=?0). The risk of leukopenia was increased in rituximab group with the pooled RR of 8.22 (95% CI 2.08–32.47). There were no statistical differences in the risks of infection, graft loss and mortality at 3–6 months after transplantation with pool RRs of 1.02 (95% CI 0.85–1.21), 0.55 (95% CI 0.21–1.48) and 0.58 (95% CI 0.17–1.99), respectively. Conclusion: This meta-analysis demonstrated insignificant reduced risks of BPAR, graft loss or mortality among in ABO-compatible, non-sensitized renal transplant recipients with rituximab induction. Although rituximab induction significantly increases risk of leukopenia, it appears to be safe with no significant risk of infection.     

High inspired oxygen versus low inspired oxygen for reducing surgical site infection: a meta‐analysis

To perform a meta‐analysis of published literature to assess the role of high‐concentration inspired oxygen in reducing the incidence of surgical site infections (SSIs) following all types of surgery, a comprehensive search for published randomized controlled trials (RCTs) comparing high‐ with low‐concentration inspired oxygen for SSIs was performed. The related data were extracted by two independent authors. The fixed and random effects methods were used to combine data. Twelve RCTs involving 6750 patients were included. Our pooled result found that no significant difference in the incidence of SSIs was observed between the two groups, but there was high statistic heterogeneity across the studies [risk ratio (RR): 0·91; 95% confidence interval (CI): 0·72–1·14; P = 0·40; I² = 54%]. The sensitivity analysis revealed the superiority of high‐concentration oxygen in decreasing the SSI rate (RR: 0·86; 95% CI: 0·75–0·98; P = 0·02). Moreover, a subgroup analysis of studies with intestinal tract surgery showed that patients experienced less SSI when high‐concentration inspired oxygen was administrated (RR: 0·53; 95% CI: 0·37–0·74; P = 0·0003). Our study provided no direct support for high‐concentration inspired oxygen in reducing the incidence of SSIs in patients undergoing all types of surgery.     

Does using comprehensive preoperative bowel preparation offer any advantage for urinary diversion using ileum? A meta-analysis

Purpose

The aim of this study was to compare the efficacy of comprehensive bowel preparation to that of limited bowel preparation in prevention of postoperative complications in elective urinary diversion surgery by using ileum.

Methods

Literature search of PubMed, EMBASE and the Cochrane Library was done to identify randomized controlled trials (RCTs) and cohort studies involving comparison of postoperative complications after comprehensive bowel preparation and limited bowel preparation. A meta-analysis was carried out to distinguish overall differences between the two groups.

Results

Our literature search yielded two randomized controlled trials and two cohort studies, involving a total of 346 patients, which met our inclusion criteria. There was no significant difference between the comprehensive bowel preparation and limited bowel preparation in wound infection [relative risk (RR) 95 % confidence interval (CI), 1.05(0.46–2.40); P = 0.86], mortality [RR 95 % CI, 1.06 (0.32–3.55); P = 0.76], ileus [RR 95 % CI, 0.86 (0.37, 2.00); P = 0.40], sepsis [RR 95 % CI, 0.71 (0.20, 2.52); P = 0.78], anastomotic leakage [RR 95 % CI, 0.81 (0.15, 4.21); P = 0.83], wound dehiscence [RR 95 % CI, 0.92 (0.40, 2.13); P = 0.67], peritonitis [RR 95 % CI, 0.64 (0.08, 5.10); P = 0.63] or fistula [RR 95 % CI, 0.71 (0.18,2.75); P = 0.63].

Conclusions

The limited evidence available demonstrated that the use of comprehensive bowel preparation for urinary diversion surgery using ileum does not offer any significant advantage over limited bowel preparation. Future work should target more high-quality RCTs to confirm this.     

昂丹司琼联合地塞米松对比昂丹司琼单药预防腹腔镜胆囊切除术后恶心呕吐的荟萃分析

目的:系统评价昂丹司琼联合地塞米松与昂丹司琼单药预防腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后恶心呕吐(postoperative nausea and vomiting,PONV)的疗效及安全性,以期为临床用药提供参考。方法:系统检索与筛选Cochrane Library、Pub Med、EMBASE、SCI、CNKI、维普、万方数据库中对比昂丹司琼单药与联合用药预防LC术后PONV的随机对照试验。使用Google学术、百度学术等搜索引擎进一步补充检索。按照纳入与排除标准纳入文献后,由两位作者独立进行质量评价、数据提取,交叉核对后,使用Rev Man 5.3软件统计分析,合并效应量中计数资料采用相对危险度(relative risk,RR)及95%可信区间(confidence interval,CI)描述。结果:纳入12项随机对照试验,共1 156例患者。Meta分析结果显示,相较昂丹司琼单药组,联合地塞米松用药组LC术后24 h内PONV发生率显著下降[RR=0.45,95%CI(0.35,0.57)]。依据药物用量行亚组分析时发现,4 mg、8 mg昂丹司琼联合用药组均可显著降低术后24 h PONV发生率,而在8 mg时较单药组可显著降低总的呕吐发生率[RR=0.40,95%CI(0.23,0.71)]。安全性方面,两组术后其他并发症发生率差异无统计学意义。结论:昂丹司琼联合地塞米松相较昂丹司琼单药能更好地预防LC术后的PONV,有效降低术后不适症状,同时临床应用时应注意昂丹司琼剂量的选择。     

Surgical treatment of diverticulitis and its complications: A systematic review and meta-analysis of randomized control trials

Purpose

The surgical interventions of diverticulitis vary according to its grade and severity. There is a controversy about the best of these different surgical procedures. We aimed to systematically review and meta-analyze randomized controlled trials (RCTs) comparing outcomes and complications between different surgical approaches for acute diverticulitis and its complications.

Intravenous administration of dexmedetomidine and quality of recovery after elective surgery in adult patients: A meta-analysis of randomized controlled trials

Study objectiveTo evaluate the efficacy and safety of pre- and perioperative intravenous administration of dexmedetomidine for enhancing quality of recovery (as measured by 40-item quality of recovery questionnaire (QoR-40), ranged from 40 to 200) after surgery.DesignMeta-analysis.SettingAdult patients undergoing elective surgery.InterventionIntravenous administration of dexmedetomidine during pre- and perioperative period.MeasurementsThe primary outcome was quality of recovery after surgery. The secondary outcome was the incidence of dexmedetomidine-related adverse events.Main resultsModerate to low quality evidence suggested that dexmedetomidine (DEX) increased the quality of recovery after surgery (WMD, weighted mean difference 15.71, 95% CI, confidence interval 0.43 to 31.00; 428 participants; 5 RCTs; low quality evidence), decreased the incidence of postoperative nauseas or vomiting (RR, risk ratio 0.60, 95% CI 0.44 to 0.83; 404 participants; 6 RCTs; moderate quality evidence; RR 0.32, 95% CI 0.19 to 0.55; 356 participants; 5 RCTs; moderate quality evidence) without increased risk of bradycardia (RR: 1.78, 95% CI 0.78 to 4.02; 275 participants; 4 RCTs; moderate quality evidence), dizziness (RR 0.78, 95% CI 0.31 to 2.00; 183 participants; 3 RCTs; moderate quality evidence), pruritus (RR 1.32, 95% CI 0.39 to 4.44; 186 participants; 3 RCTs; moderate quality evidence), hypotension requiring an intervention (RR: 1.48, 95% CI, 0.68 to 3.23; 254 participants; 3 RCTs; moderate quality evidence) and longer length of hospital stay (WMD: −0.75 days, 95% CI −1.95 to 0.44; 246 participants; 3 RCTs; low quality evidence) in early postoperative period.ConclusionsDexmedetomidine as an anesthetic adjuvant to general anesthesia was associated with an enhanced quality of recovery (15.71; far more than a clinically significant improvement of 6.3) without increased risk of adverse events in the early postoperative period (moderate to low quality evidence). Further large sample and high quality RCTs are needed to confirm the current findings.