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1.

Background

Pulmonary recruitment maneuver (PRM) at the end of laparoscopic gynecologic surgery has been shown to reduce postoperative pain. This prospective, randomized, controlled clinical trial aimed to investigate postoperative pain (primary endpoint) and nausea when performing a ventilator-piloted PRM at the end of laparoscopic bariatric surgery.

Settings

A secondary-level public hospital in Sweden.

Methods

After giving written consent, patients undergoing elective laparoscopic bariatric surgery were randomized to receive routine exsufflation (control group) or a ventilator-piloted PRM to remove residual carbon dioxide from the abdomen at the end of surgery. Pain and nausea intensities were recorded at 4, 12, 24, 36, and 48 hours after surgery using a questionnaire with numeric rating scales. Postoperative consumption of analgesics and antiemetics was also evaluated.

Results

There were 150 randomly assigned patients recruited, 79 to PRM intervention and 71 controls. Pain intensity was significantly lower in the PRM group than in the control group 24 hours postoperatively (numeric rating scale 2 [1–3] versus 3 [2–5]; P = .002). Pain during the first 24 hours did not increase in the PRM group as it did in the control group (P = .045). Opioid requirements were significantly lower in the PRM group than in the control group (5.0 mg [2–10] versus 9.0 mg [5–15]; P = .025). The PRM did not affect incidence or intensity of nausea and vomiting.

Conclusions

A ventilator-piloted PRM reduced postoperative pain intensity and opioid requirement after laparoscopic bariatric surgery. The heterogeneity of the study population and the large number of hospital staff involved indicate good generalizability of the results.  相似文献   

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Purpose

The aim of our study was to evaluate the safety and effectiveness of early enteral nutrition (EN) for patients after pancreatoduodenectomy (PD).

Methods

We performed a comprehensive search of abstracts in the MEDLINE database, OVID database, Springer database, the Science Citation Index, and the Cochrane Library database. Published data of randomized clinical trials (RCTs) comparing the clinically relevant outcomes of early EN and other nutritional routes for patients after PD were analyzed. The analyzed outcome variables included gastroparesis, intra-abdominal complications (gastroparesis excluded), mortality, infection, and postoperative hospital stay. The Cochrane Collaboration’s RevMan 5.1 software was used for statistical analysis.

Results

Four RCTs published in 2000 or later were included in this meta-analysis, in which 246 patients underwent early EN and 238 patients underwent other nutritional routes following PD. In the combined results of early EN versus other nutritional routes, no significant difference could be found in gastroparesis (odds ratio (OR), 0.89; 95 % CI, 0.36–2.18; P?=?0.79), intra-abdominal complications (gastroparesis excluded) (OR, 0.82; 95 % CI, 0.53–1.26; P?=?0.37), mortality (OR, 0.43; 95 % CI, 0.11–1.62; P?=?0.21), infection (OR, 0.55; 95 % CI, 0.29–1.07; P?=?0.08), postoperative hospital stay (mean difference, ?0.93; 95 % CI, ?6.51 to 4.65; P?=?0.74).

Conclusions

Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.  相似文献   

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BackgroundDexmedetomidine in opioid-sparing analgesia promotes enhanced recovery and improves postoperative outcomes.ObjectivesThis study aimed to explore the safety and efficacy of dexmedetomidine in bariatric surgery.SettingMeta-analysis.MethodsWe selected studies from Pubmed, Embase, Web of Science, and the Cochrane Central Registry of Controlled Trials before 20 April, 2021. The primary outcomes were pain scores and intravenous morphine equivalents (IVME) in the post anesthesia care unit (PACU) and postoperative day 1 (POD1). The secondary outcomes included postoperative nausea and vomiting (PONV), the length of hospital stay (LOS), intraoperative mean arterial pressure (MAP) and heart rate (HR).ResultsWe extracted 697 participants from 10 randomized controlled trials. Dexmedetomidine reduced PACU pain scores (MD = ?1.51, 95% confidence interval [CI]: ?2.60 to ?.42) after bariatric surgery, especially laparoscopic Roux-en-Y gastric bypass (MD = ?3.05, 95%CI: ?3.77 to ?2.33), but it did not affect POD1 pain scores (MD = .20, 95%CI: ?.85 to 1.26). Dexmedetomidine can reduce PACU IVME (MD = ?4.29, 95%CI: ?6.59 to ?1.99), but does not reduce POD1 IVME (MD = ?.36, 95%CI: ?2.41 to 1.68). In addition, dexmedetomidine significantly reduced PONV both in PACU (OR = .28, 95%CI: .14–.54) and POD1 (OR = .24, 95%CI: .14–.4), shortened LOS (MD = ?.29, 95%CI: ?.49 to ?.10), and had little effect on intraoperative MAP (MD = ?6.64, 95%CI: ?9.52 to ?3.76) and HR (MD = ?4.8, 95%CI: ?11.55 to 1.94).ConclusionIn conclusion, the use of dexmedetomidine in opioid-sparing analgesia contributes to postoperative analgesia after bariatric surgery, but the heterogeneity was high. In addition, dexmedetomidine is beneficial for enhanced recovery.  相似文献   

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目的:系统评价腹腔镜胆囊切除术后腹腔内引流的有效性。方法:系统检索PubMed、Embase、Web of Science、Cochrane对照试验中心登记册及Cochrane图书馆(2018年11期)、CBM、CNKI、VIP等数据库。系统评价根据PRISMA指南进行,并采用固定与随机效应模型进行Meta分析。结果:共22项研究涉及3 866例患者的RCTs(其中引流组2 003例,非引流组1 863例)纳入研究。Meta分析结果显示,两组腹腔内液体发生率[RR=1.26,95%CI(0.92,1.72),P=0.16]、术后死亡率[RR=0.44,95%CI(0.04,4.72),P=0.50]差异无统计学意义。术后放置腹腔引流未能降低恶心或/和呕吐的总体发生率[RR=1.16,95%CI(0.95,1.42),P=0.15]、肩部疼痛发生率[RR=0.93,95%CI(0.71,1.23),P=0.62]。引流组具有更高的疼痛评分(通过视觉模拟评分测量)[MD=1.00,95%CI(0.58,1.42),P<0.00001],更长的手术时间[MD=6.07,95%CI(2.07,10.08),P=0.003]、术后住院时间[MD=0.73,95%CI(0.29,1.17),P=0.001]。切口感染与放置腹腔引流无关[RR=1.61,95%CI(0.97,2.69),P=0.07]。结论:腹腔镜胆囊切除术术毕放置引流管并无明显优势,腹腔引流的常规使用似乎具有不利的临床结果,对于这种措施应重新考虑。  相似文献   

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OBJECTIVES: To determine whether meta-analysis supports the use of corticosteroids to reduce post-tonsillectomy pain for pediatric patients. METHODS: A systematic review of currently available randomized controlled trials using a single-dose, intravenous corticosteroid during pediatric tonsillectomy was performed. Visual analog pain scale (VAS) data was extracted with reviewers blinded to results. Meta-analysis was performed with weighted mean difference and random-effects model using Revman 4.2 software. RESULTS: Eight randomized trials were included in analysis of post-tonsillectomy pain. A statistically significant reduction in pain as measured by VAS on postoperative day 1 was noted (mean VAS difference = -0.97; CI 95 % = -1.74,-0.19; P = 0.01). CONCLUSIONS: A single, intraoperative dose of dexamethasone may reduce post-tonsillectomy pain on postoperative day 1, by a factor of 1 on a 10-point pain scale. As the side effects and cost of dexamethasone dose appear negligible, consideration of routine use seems reasonable.  相似文献   

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OBJECT: The authors undertook this meta-analysis to assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in addition to opioid analgesics on perioperative pain management in lumbar spine surgery. METHODS: The authors searched MEDLINE, Excerpta Medica (EMBASE), The Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine (AMED), and Science Citation Index Expanded databases. In addition, they manually searched key journals and their references. They included randomized trials comparing the use of NSAIDs in addition to opioid analgesics versus opioid analgesics alone after posterior lumbar discectomy, laminectomy, or spinal fusion. Two independent reviewers performed an assessment of the quality of the methods. RESULTS: Seventeen studies comprising 400 patients who received NSAIDs in addition to opioid analgesics and 389 patients receiving opioid analgesics alone were included. Patients receiving NSAIDs in addition to opioid analgesics had lower pain scores and consumed fewer opioids than the group receiving opioid analgesics alone. There was no difference in the incidence of adverse effects. CONCLUSIONS: This meta-analysis provides evidence that the addition of NSAIDs to opioid analgesics in lumbar spine surgery provided better pain control than opioid analgesics alone.  相似文献   

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Background

The best reconstruction method for the pancreatic remnant after pancreaticoduodenectomy remains debatable. We aimed to investigate the perioperative outcomes of 2 popular reconstruction methods: pancreaticogastrostomy and pancreaticojejunostomy.

Data Sources

Randomized controlled trials comparing pancreaticogastrostomy versus pancreaticojejunostomy were identified from literature databases (MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Library).The meta-analysis included 8 studies: 607 patients who underwent pancreaticogastrostomy and 604 who underwent pancreaticojejunostomy. Postoperative pancreatic fistula and intra-abdominal fluid collection rates were significantly lower after pancreaticogastrostomy compared with pancreaticojejunostomy. No statistically significant differences were found in the incidence of delayed gastric emptying, biliary fistula, hemorrhage, reoperation, wound infection, overall morbidity, mortality, and length of hospital stay.

Conclusions

Our meta-analysis suggests that pancreaticogastrostomy not only reduces the rate of postoperative pancreatic fistula but also decreases its severity. Pancreaticogastrostomy is associated with a lower rate of intra-abdominal fluid collection. Our results suggest that pancreaticogastrostomy should be the preferred reconstruction method.  相似文献   

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Introduction

Various strategies have been proposed for postoperative pain control. Among those, intravenous lidocaine infusion (IVLI) has gained in interest. However, its clinical benefit remains unclear. This systematic review is an evaluation of the analgesic efficacy and safety of IVLI during general anesthesia.

Methods

A systematic search was performed using MEDLINE, EMBASE, Cochrane, and SCOPUS databases, likewise, grey literature. The review included all randomized controlled trials that used a placebo or any comparator and evaluated IVLI during general anesthesia for any type of surgery. Primary outcomes were pain control and opioid requirement. Secondary outcomes were mortality, length of stay, ileus recovery time, nausea/vomiting, and adverse events. Random effects models were used and heterogeneity was assessed using the I2 index.

Results

From 5,472 citations retrieved, 29 studies involving a total of 1,754 patients met eligibility. At six hours postoperatively, intravenous lidocaine infusion reduced pain at rest (weighted mean difference [WMD] ?8.70, 95% confidence intervals [CI] ?16.19 to ?1.21), during cough (WMD ?11.19, 95% CI ?17.73 to ?4.65), and during movement (WMD ?9.56, 95% CI ?17.31 to ?1.80). Intravenous lidocaine infusion also reduced opioid requirement (morphine) (WMD ?8.44 mg, 95% CI ?11.32 to ?5.56), time to first flatus (WMD ?7.62 hr, 95% CI ?10.78 to ?4.45), time to first feces (WMD ?10.71 hr, 95% CI ?16.14 to ?5.28), nausea/vomiting (risk ratios = 0.71, 95% CI 0.57-0.90), and hospital length of stay (WMD ?0.17 days, 95% CI ?0.41 to 0.07). Abdominal surgery was strongly associated with benefit. For the 12 studies that systematically screened adverse events, the incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels.

Discussion

Perioperative IVLI reduced postoperative pain and opioid requirement, as well as ileus recovery time, hospital length of stay, and nausea/vomiting. Intravenous lidocaine infusion was effective mainly in abdominal surgery populations. Considering that toxic levels were detected and that adverse events were not systematically screened for in most studies, dose and safety of IVLI should be established before recommending its use.  相似文献   

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目的 分析国内外相关文献资料,比较肠内营养(EN)、肠外营养(PN)对胃肠手术患者预后的影响,探讨胃肠术后早期应用EN的合理性.方法 检索PubMed、EMBASE和Cochrane图书馆数据库,对1970年至2008年中胃肠手术后给予EN、PN相关的临床随机对照试验进行荟萃分析.评价终止的指标包括吻合口裂开、感染(包括导管脓毒症、伤口感染、肺炎、腹腔脓肿、泌尿系感染)、呕吐及腹胀、其他并发症、住院天数和病死率.结果 23组临床随机实验共2784例患者符合录入标准.与PN组比较,EN可减少吻合口裂开(RR=0.67,95%Cl:0.50~0.91;P=0.010)、感染(RR=0.72,95%CI:0.64~0.81;P<0.001),其他并发症(RR=0.82,95%CI:0.73~0.92;P<0.001)和住院的时间(加权均数差值=-3.60;95% CI:-3.88~-3.32;P<0.001).但EN组腹胀和呕吐的不良反应更多见(RR=1.39,95%CI:1.21~1.59;P<0.001).两组病死率比较差异无统计学意义(P=0.400).结论 胃肠手术后患者没有"禁食水"的必要,早期给予EN辅助治疗,有利于促进患者恢复,减少并发症的发生.  相似文献   

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