Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI Research School, Maastricht University, The Netherlands.
Department of General and Vascular Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands.
Int J Surg. 2014;12(2):134-40. doi: 10.1016/j.ijsu.2013.11.018. Epub 2013 Dec 8.
The impact of postoperative complications after Major Abdominal Surgery (MAS) is substantial, especially when socio-economical aspects are taken into account. This systematic review focuses on the effects of preoperative exercise therapy (PEXT) on physical fitness prior to MAS, length of hospital admission and postoperative complications in patients eligible for MAS, and on what is known about the most effective kind of exercise regime.
A systematic search identified randomised controlled trials on exercise therapy and pulmonary physiotherapy prior to MAS. The methodological quality of the included studies was rated using the 'Delphi List For Quality Assessment of Randomised Clinical Trials'. The level of agreement between the two reviewers was estimated with Cohen's kappa.
A total of 6 studies were included, whose methodological quality ranged from moderate to good. Cohen's kappa was 0.90. Three studies reported on improving physical fitness prior to MAS with the aid of PEXT. Two studies reported on the effect of training on postoperative complications, showing contradictory results. Three studies focused on the effect of preoperative chest physiotherapy on postoperative lung function parameters after MAS. While the effects seem positive, the optimal training regime is still unclear.
Preoperative exercise therapy might be effective in improving the physical fitness of patients prior to major abdominal surgery, and preoperative chest physiotherapy seems effective in reducing pulmonary complications. However consensus on training method is lacking. Future research should focus on the method and effect of PEXT before high-risk surgical procedures.
大腹部手术后（MAS）的术后并发症影响巨大，特别是考虑到社会经济方面。本系统评价重点关注 MAS 前术前运动疗法（PEXT）对身体适应性、住院时间和术后并发症的影响，以及关于最有效运动方案的了解。
系统搜索了 MAS 前运动疗法和肺物理疗法的随机对照试验。使用“德尔菲清单对随机临床试验进行质量评估”对纳入研究的方法学质量进行了评估。两位审稿人之间的一致性用 Cohen's kappa 进行评估。
共纳入 6 项研究，其方法学质量从中等到良好不等。Cohen's kappa 为 0.90。三项研究报告了 PEXT 术前改善身体适应性的情况。两项研究报告了训练对术后并发症的影响，结果相互矛盾。三项研究侧重于 MAS 后术前胸部物理疗法对术后肺功能参数的影响。虽然效果似乎是积极的，但最佳的训练方案仍不清楚。
术前运动疗法可能有效改善 MAS 前患者的身体适应性，术前胸部物理疗法似乎能有效降低肺部并发症。但是，缺乏关于训练方法的共识。未来的研究应集中在高危手术前的 PEXT 方法和效果上。
