择期腹部大手术高危患者的个性化术前康复：一项随机双盲对照试验

Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial.

作者信息

Barberan-Garcia Anael, Ubré Marta, Roca Josep, Lacy Antonio M, Burgos Felip, Risco Raquel, Momblán Dulce, Balust Jaume, Blanco Isabel, Martínez-Pallí Graciela

机构信息

Respiratory Medicine Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERES.

Anesthesiology Department, Hospital Clínic de Barcelona.

出版信息

Ann Surg. 2018 Jan;267(1):50-56. doi: 10.1097/SLA.0000000000002293.

DOI:10.1097/SLA.0000000000002293

PMID:28489682

Abstract

OBJECTIVE

The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery.

SUMMARY BACKGROUND DATA

Prehabilitation, including endurance exercise training and promotion of physical activity, in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications. However, the existing studies provide controversial results and show a clear bias toward low-risk patients.

METHODS

This was a randomized blinded controlled trial. Eligible candidates accepting to participate were blindly randomized (1:1 ratio) to control (standard care) or intervention (standard care + prehabilitation) groups. Inclusion criteria were: i) age >70 years; and/or, ii) American Society of Anesthesiologists score III/IV. Prehabilitation covered 3 actions: i) motivational interview; ii) high-intensity endurance training; and promotion of physical activity. The main study outcome was the proportion of patients suffering postoperative complications. Secondary outcomes included the endurance time (ET) during cycle-ergometer exercise.

RESULTS

We randomized 71 patients to the control arm and 73 to intervention. After excluding 19 patients because of changes in the surgical plan, 63 controls and 62 intervention patients were included in the intention-to-treat analysis. The intervention group enhanced aerobic capacity [ΔET 135 (218) %; P < 0.001), reduced the number of patients with postoperative complications by 51% (relative risk 0.5; 95% confidence interval, 0.3-0.8; P = 0.001) and the rate of complications [1.4 (1.6) and 0.5 (1.0) (P = 0.001)] as compared with controls.

CONCLUSION

Prehabilitation enhanced postoperative clinical outcomes in high-risk candidates for elective major abdominal surgery, which can be explained by the increased aerobic capacity.

摘要

目的

本研究旨在评估个性化术前康复对接受择期腹部大手术的高危患者术后并发症的影响。

总结背景数据

对于接受腹部大手术的患者，术前康复（包括耐力运动训练和促进身体活动）被认为是一种有效的预防干预措施，可减少术后并发症。然而，现有研究结果存在争议，且明显偏向低风险患者。

方法

这是一项随机双盲对照试验。接受参与的符合条件的候选人被随机（1:1比例）分为对照组（标准护理）或干预组（标准护理+术前康复）。纳入标准为：i）年龄>70岁；和/或ii）美国麻醉医师协会评分III/IV级。术前康复包括三个方面：i）动机性访谈；ii）高强度耐力训练；以及促进身体活动。主要研究结果是术后出现并发症的患者比例。次要结果包括蹬车运动期间的耐力时间（ET）。

结果

我们将71例患者随机分配至对照组，73例至干预组。由于手术计划变更排除19例患者后，63例对照组和62例干预组患者纳入意向性分析。与对照组相比，干预组提高了有氧运动能力[ET增加135（218）%；P<0.001]，术后并发症患者数量减少51%（相对风险0.5；95%置信区间，0.3 - 0.8；P = 0.001），并发症发生率[分别为1.4（1.6）和0.5（1.0）（P = 0.001）]。