Zhang Xiongxin, Zheng Wei, Chen Chaoqin, Kang Xianhui, Zheng Yueying, Bao Fangping, Gan Shuyuan, Zhu Shengmei
Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
Medicine (Baltimore). 2018 Nov;97(45):e13097. doi: 10.1097/MD.0000000000013097.
Perioperative goal-directed fluid therapy (GDFT) aiming to maintain individual fluid balance based on sensitive parameters was prevalent in major surgery, especially in enhanced recovery after surgery (ERAS) pathway. This meta-analysis was conducted for the purpose of evaluating whether GDFT impacts on occurrence of postoperative ileus and whether its application is worthwhile in gastrointestinal surgery.
A systematic search of RCTs compared GDFT with other fluid management in patients undergoing gastrointestinal surgery from the PubMed, Web of Science, Embase, Cochrane Library databases was implemented. The primary outcome is incidence of postoperative ileus. Other outcome measures were length of hospital stay (LOS), postoperative morbidity and mortality. Subgroup analysis was planed a prior to verify the definite role of GDFT.
12 trials consisted of 1836 patients were included in the final analysis. GDFT did not influence the occurrence of postoperative ileus (relative risk, RR 0.71, 95% confidence interval, CI 0.47-1.07, P = .10), with moderate heterogeneity (I = 29%, P = .16). No difference was found between GDFT and control groups in LOS (mean difference -0.17 days, 95% CI -0.73 to 0.39, P = .55), total complication rate (RR 0.92, 95% CI 0.81-1.05, P = .23), and 30-day mortality (RR 0.91, 95% CI 0.47-1.75, P = .77). In other secondary outcomes, only wound infection rate was lower in the GDFT group (RR 0.68, 95% CI 0.50-0.93, P = .02). When performed subgroup analysis, GDFT was superior in reduction ileus only when compared with standard therapy or in those outside ERAS.
It is possible that GDFT dose not affect the occurrence of postoperative ileus in gastrointestinal surgery. It scarcely influences postoperative morbidity and mortality as well. However, lower incidence of ileus is observed in GDFT group either outside ERAS or compared with standard fluid therapy. Probably, GDFT may not be necessary in the ERAS pathway or if a hybrid approach is adopted.
旨在根据敏感参数维持个体液体平衡的围手术期目标导向性液体治疗（GDFT）在大手术中很普遍，尤其是在术后加速康复（ERAS）路径中。本荟萃分析旨在评估GDFT是否会影响术后肠梗阻的发生，以及其在胃肠手术中的应用是否值得。
对PubMed、Web of Science、Embase、Cochrane图书馆数据库中比较GDFT与其他液体管理方法在接受胃肠手术患者中的随机对照试验（RCT）进行系统检索。主要结局是术后肠梗阻的发生率。其他结局指标包括住院时间（LOS）、术后发病率和死亡率。预先计划进行亚组分析以验证GDFT的明确作用。
最终分析纳入了12项试验，共1836例患者。GDFT不影响术后肠梗阻的发生（相对危险度，RR 0.71，95%置信区间，CI 0.47-1.07，P = 0.10），异质性中等（I = 29%，P = 0.16）。GDFT组与对照组在LOS（平均差 -0.17天，95%CI -0.73至0.39，P = 0.55）、总并发症发生率（RR 0.92，95%CI 0.81-1.05，P = 0.23）和30天死亡率（RR 0.91，95%CI 0.47-1.75，P = 0.77）方面无差异。在其他次要结局中，只有GDFT组的伤口感染率较低（RR 0.68，95%CI 0.50-0.93，P = 0.02）。进行亚组分析时，仅在与标准治疗相比或在非ERAS患者中，GDFT在减少肠梗阻方面更具优势。
GDFT可能不会影响胃肠手术中术后肠梗阻的发生。它对术后发病率和死亡率也几乎没有影响。然而，在非ERAS患者中或与标准液体治疗相比时，GDFT组的肠梗阻发生率较低。可能在ERAS路径中或采用混合方法时，GDFT可能没有必要。
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